What is a Lisinopril Cough?
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor, a common medication used to treat high blood pressure and heart failure. While effective, one of its most common side effects is a persistent, dry cough. The cough is often described as ticklish or scratchy, and it is almost always non-productive, meaning it doesn't produce any mucus or phlegm.
Symptoms of a lisinopril cough typically begin within the first few weeks or months of starting the medication, though in some cases, the onset may be delayed for up to six months. This delayed onset is a significant factor, as it can make connecting the cough to the medication less obvious. The cough is known for its persistent nature and will not typically respond to conventional over-the-counter cough suppressants.
The Cause: Why Lisinopril Can Trigger a Cough
Lisinopril and other ACE inhibitors work by blocking the angiotensin-converting enzyme in the body. While this is beneficial for lowering blood pressure, it also interferes with the breakdown of other substances, including an inflammatory protein called bradykinin. The buildup of bradykinin in the airways and lungs is thought to irritate nerve endings and stimulate the cough reflex, leading to the characteristic dry, hacking cough. Factors that may increase the risk of developing this side effect include being female, a nonsmoker, older, or of Asian descent.
How to Differentiate Your Cough from Other Causes
Since many conditions can cause a cough, it is crucial to consider all possibilities. A lisinopril cough is distinguished by its dry, persistent, and non-productive nature, which often develops after beginning the medication. Here is a comparison to help distinguish it from other common types of coughs:
| Feature | Lisinopril Cough | Viral Infection (e.g., Cold) | Allergies/Post-Nasal Drip | Heart Failure Cough |
|---|---|---|---|---|
| Sensation | Tickling or scratching in the throat | Often accompanied by a sore throat | Itchy throat, possibly with watery eyes and sneezing | Can be a wet cough with a heavy feeling |
| Productivity | Almost always dry and non-productive | Initially dry, can become productive (with mucus) | Often accompanied by a feeling of drainage, can be productive | Often wet, may produce pink or blood-tinged mucus |
| Onset & Duration | Develops weeks to months after starting lisinopril; persists as long as medication is taken | Develops quickly after exposure; usually resolves within 1–2 weeks | Tends to be seasonal or occurs upon allergen exposure; may last for weeks | Often chronic; can worsen when lying down |
| Associated Symptoms | Typically no other symptoms aside from the cough | Fever, aches, sore throat, congestion | Sneezing, runny nose, itchy eyes | Shortness of breath, swelling in the legs, fatigue |
| Response to Treatment | Does not respond to cough suppressants; resolves after stopping lisinopril | Responds to rest and cold remedies | Responds to antihistamines or allergy treatments | Requires treatment of the underlying heart condition |
Taking Action: Next Steps and Medical Consultation
If you suspect that your lisinopril medication is the cause of your persistent cough, follow these critical steps:
- Do not stop taking the medication on your own. Abruptly stopping lisinopril can cause your blood pressure to spike, which can be dangerous.
- Contact your healthcare provider. Schedule an appointment to discuss your symptoms. Be prepared to share when the cough started, its characteristics, and how it is affecting your quality of life.
- Explore a trial discontinuation. Your doctor may recommend a controlled trial of stopping the medication to see if the cough resolves. A lisinopril cough will typically disappear within one to four weeks after discontinuation, although it can take up to three months.
- Consider alternative treatments. If the cough proves to be from lisinopril, your doctor may switch you to a different class of blood pressure medication, most commonly an angiotensin II receptor blocker (ARB). ARBs like losartan or valsartan work similarly to ACE inhibitors but do not typically cause a cough because they affect bradykinin levels differently.
- Evaluate for other causes. Even if you are taking lisinopril, your cough may have another cause, such as a respiratory infection, GERD, or asthma. Your doctor will help rule out other conditions to ensure you receive the correct diagnosis and treatment.
Conclusion
While a lisinopril-induced cough can be an irritating side effect, it is important to remember that it is not dangerous. By understanding the typical characteristics of this medication-related cough—including its dry, persistent nature and its onset after starting the drug—you can have an informed conversation with your doctor. The most effective way to confirm the cause is to work with your healthcare provider to safely stop the medication and observe if the cough subsides, allowing you to find an alternative treatment if necessary.
For more detailed information on cardiovascular health, consider consulting resources from the American Heart Association.
