Does losartan make you cough?

October 10, 2025 •

4 min read

A persistent dry cough is a well-known side effect of certain blood pressure medications, particularly ACE inhibitors. But does losartan make you cough? While less common than with ACE inhibitors, a cough is still a possible side effect of the angiotensin receptor blocker (ARB) losartan, though frequently it may be a carry-over effect from a previous ACE inhibitor. This article explores the pharmacological reasons behind this issue and distinguishes the risk factors associated with losartan versus other blood pressure drugs.

Quick Summary

Losartan can cause a cough, though it is far less likely than with ACE inhibitors. For many patients, a cough may be a carry-over effect from prior ACE inhibitor use, but it can also occur independently. Understanding this distinction is crucial for managing symptoms and determining the appropriate course of action.

Key Points

Losartan vs. ACE Inhibitors: Losartan (an ARB) is significantly less likely to cause a persistent cough than ACE inhibitors like lisinopril.
Carry-over Effect: The most common reason for a cough on losartan is a "carry-over" from a previously taken ACE inhibitor.
De Novo Cough: A new cough can still develop from losartan directly, but this is a rare side effect.
Action Plan: If a cough develops, consult a doctor to determine the cause and explore alternative medications if necessary.
Underlying Causes: A cough may be caused by other health issues, such as allergies or respiratory infections, rather than the medication.
Mechanism of Action: The difference in cough incidence is due to ARBs not causing the buildup of bradykinin, a substance that triggers coughing.

Understanding the difference: ARBs vs. ACE Inhibitors

To understand why a cough is associated with losartan, it's essential to first differentiate it from its more famous cough-inducing counterparts: ACE inhibitors. Both are used to treat high blood pressure, but they operate through different mechanisms within the renin-angiotensin-aldosterone system (RAAS).

ACE Inhibitors (e.g., lisinopril, enalapril, ramipril): These drugs block the enzyme that converts angiotensin I to angiotensin II. This inhibition leads to the accumulation of other substances, most notably bradykinin, in the lungs. The buildup of bradykinin is the primary cause of the irritating, persistent, dry cough associated with ACE inhibitors. The cough is not typically serious but can be bothersome enough to necessitate a medication change.
Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan): Losartan and other ARBs work differently. They block the angiotensin II receptor, preventing the hormone from binding and causing its blood pressure-raising effects. Because ARBs do not inhibit the enzyme that breaks down bradykinin, they theoretically should not cause a cough. This is why ARBs are often prescribed to patients who could not tolerate an ACE inhibitor due to the cough.

The reality: Why a cough with losartan is still possible

Despite the different mechanism of action, a cough can still occur with losartan, albeit at a much lower frequency. Several factors contribute to this phenomenon:

The Carry-over effect

One of the most significant reasons for a cough with losartan is a "carry-over" effect from previous ACE inhibitor therapy. Patients are often switched from an ACE inhibitor to an ARB precisely because of a cough. If the new medication is started immediately after stopping the old one, the residual effects of the ACE inhibitor may continue to cause a cough for a period. A large study using Prescription-Event Monitoring found that a high percentage of patients who stopped losartan due to a cough had previously experienced a cough with an ACE inhibitor, indicating this carry-over effect.

Drug-induced cough (de novo)

While less common, it is possible for a cough to develop de novo (anew) from losartan itself. The exact mechanism is not fully understood but may involve subtle effects on other pathways or individual sensitivities. Case reports have documented patients who developed a cough on losartan that resolved upon discontinuation and, in at least one instance, switching to an ACE inhibitor resolved the issue. This highlights the unpredictable nature of drug side effects and the importance of individual patient responses.

Other common causes

It is also crucial to remember that a cough can have many other causes unrelated to medication. When a cough develops while taking losartan, a healthcare provider will evaluate other potential culprits, including:

Upper respiratory tract infections (URTIs)
Asthma or other pulmonary conditions
Allergies
Gastroesophageal reflux disease (GERD)

ACE Inhibitors vs. ARBs: Cough Side Effect Comparison

To illustrate the difference in cough prevalence, the table below provides a general comparison based on clinical observations and user-reported experiences.


Feature	ACE Inhibitors (e.g., Lisinopril)	ARBs (e.g., Losartan)
Mechanism of action	Blocks the ACE enzyme, causing bradykinin accumulation.	Blocks angiotensin II receptors, does not affect bradykinin breakdown.
Incidence of cough	Common (5% to 20% of users).	Rare (Much lower incidence).
Nature of cough	Persistent, dry, and non-productive.	Can be similar, but less frequent and severe.
Typical Onset	Within the first few weeks of therapy.	Can be a carry-over from ACE inhibitor or develop later.
Resolution	Usually resolves within a week after discontinuing the drug.	Often resolves upon discontinuation, especially if it was a de novo effect.

What to do if you develop a cough on losartan

If you experience a persistent cough while taking losartan, it is important not to ignore it. Here's a general guide on how to proceed:

Consult your doctor: Always inform your healthcare provider about any new or persistent side effects. They can help determine the likely cause.
Evaluate for carry-over effect: If you were recently switched from an ACE inhibitor, your doctor may recommend waiting to see if the cough resolves over time.
Consider other causes: Your doctor will investigate other potential reasons for the cough to rule out unrelated health issues.
Discuss alternative medications: If losartan is the confirmed cause of the cough, your doctor may consider switching you to a different class of blood pressure medication.
Don't stop treatment suddenly: Never stop taking losartan or any prescribed medication without first speaking to your doctor. Sudden discontinuation of blood pressure medication can be dangerous.

Conclusion: Losartan cough is real but less frequent

In summary, while losartan is often a preferred alternative for patients who cannot tolerate the cough associated with ACE inhibitors, it is not entirely immune to causing this side effect. While the risk of a de novo losartan cough is relatively low, patients may still experience a cough, often due to a carry-over effect from previous medication. The key is to communicate with your healthcare provider to accurately identify the cause and determine the best course of action. This collaboration ensures effective blood pressure management while minimizing bothersome side effects.

Medications That Cause Coughing - GoodRx

Frequently Asked Questions

No, a cough from losartan is not a common side effect. The incidence is much lower compared to ACE inhibitors, which are notorious for causing a persistent dry cough.

The cough associated with losartan, though rare, is typically described as a dry, non-productive cough, similar to the type seen with ACE inhibitors.

Yes, switching from an ACE inhibitor to an ARB like losartan is a common strategy to resolve a drug-induced cough. However, it may take some time for the cough to fully subside due to potential carry-over effects.

If the cough is confirmed to be caused by losartan, it typically resolves within a week after discontinuing the drug. However, this should only be done under a doctor's supervision.

ACE inhibitors cause a cough by inhibiting the breakdown of bradykinin, which irritates the airways. Losartan, an ARB, does not affect bradykinin levels, which is why it is much less likely to cause a cough.

It is important to see a healthcare provider to investigate other potential causes of your cough, such as allergies, respiratory infections, or asthma, to ensure you receive the correct treatment.

Yes, a persistent cough should always be discussed with your doctor. While often benign, it is important to rule out other medical conditions and determine if your medication is the cause.