How to stop a cough from blood pressure medication?

Approximately 5% to 35% of people taking a type of blood pressure medication called an ACE inhibitor develop a persistent, dry cough. This common side effect can be disruptive, but there are effective medical strategies for patients who need to know how to stop a cough from blood pressure medication while maintaining their cardiovascular health.

Quick Summary

A persistent cough from an ACE inhibitor is caused by bradykinin buildup and is typically resolved by changing medication. Discuss switching to an ARB or other alternatives with your doctor. Home remedies may offer temporary relief, but altering your prescription without medical advice is dangerous.

Key Points

• Consult Your Doctor: Never stop taking an ACE inhibitor without first speaking to your healthcare provider, as abrupt discontinuation can be dangerous.

• Switch to an ARB: The most effective way to stop an ACE inhibitor-induced cough is to switch to an Angiotensin II Receptor Blocker (ARB), which is less likely to cause this side effect.

• Understand the Cause: The cough is primarily caused by an accumulation of the substance bradykinin in the airways due to ACE inhibitor use.

• Alternative Medications Exist: If an ARB is not suitable, other options like calcium channel blockers or diuretics can be used to manage blood pressure.

• Home Remedies Offer Symptom Relief: Supportive measures like drinking honey and warm fluids or using a humidifier can temporarily soothe throat irritation, but they do not solve the root cause.

• Expect Delayed Resolution: After stopping the ACE inhibitor, it may take several weeks for the cough to resolve completely, though some relief should be felt sooner.

• Recognize the Type of Cough: An ACE inhibitor cough is typically a persistent, non-productive dry cough.

Understanding the Link Between Blood Pressure Medication and Cough

The most common cause of a cough linked to blood pressure medication is a class of drugs known as angiotensin-converting enzyme (ACE) inhibitors. These medications are widely prescribed to treat high blood pressure, heart failure, and other cardiovascular conditions by blocking the production of angiotensin II, a hormone that constricts blood vessels.

The cough is a side effect caused by an increase in the chemical bradykinin. The same enzyme that converts angiotensin I to angiotensin II (the ACE enzyme) also breaks down bradykinin. When an ACE inhibitor blocks this enzyme, bradykinin and substance P can build up in the lungs and airways. This accumulation is thought to trigger the cough reflex, leading to a persistent, non-productive dry cough. The cough can begin at any point after starting the medication, from within hours to months later.

Why the Cough Doesn't Always Happen Immediately

The delayed onset of the cough can sometimes make it difficult for patients and doctors to connect it to the medication. Some studies suggest that the cough may even resolve spontaneously in a minority of patients over time, although for many, it will persist as long as the medication is taken. The persistence and intensity of the cough vary among individuals, and genetics may play a role in how susceptible a person is to this side effect.

Medical Strategies to Stop a Medication-Induced Cough

For many patients, the most effective solution is a medication change, which should only be done under a doctor's supervision. Never stop taking your prescribed medication abruptly, as this can have serious health consequences.

Switching to an ARB

Angiotensin II receptor blockers (ARBs) are the most common and recommended alternative for patients who develop an ACE inhibitor cough. ARBs work differently by blocking the action of angiotensin II at its receptor sites instead of blocking the enzyme that produces it. Because they do not interfere with the breakdown of bradykinin, the risk of developing a cough is significantly lower, closer to that of a placebo.

Some common ARBs include:

• Losartan (Cozaar)
• Valsartan (Diovan)
• Candesartan (Atacand)

Trying a Different Class of Blood Pressure Medicine

If an ARB is not a suitable option, other classes of antihypertensive drugs can be used. These include:

• Calcium Channel Blockers: These medications relax and widen blood vessels. Common examples include amlodipine (Norvasc) and nifedipine.
• Diuretics (Water Pills): These help the body get rid of excess sodium and water. Hydrochlorothiazide is a common example.
• Beta-Blockers: These medications slow the heart rate and reduce blood pressure. Examples include atenolol and metoprolol.

What to Expect When You Switch

After discontinuing an ACE inhibitor, the cough will typically resolve within one to four weeks. In some cases, it may take up to three months. Your doctor will monitor your blood pressure closely during this transition to ensure that your hypertension remains under control.

Home Remedies and Supportive Care

While home remedies cannot resolve the underlying cause of an ACE inhibitor cough, they can provide temporary relief from the associated throat irritation and dryness.

Here are some supportive care options:

• Stay Hydrated: Drinking plenty of fluids, such as water, warm tea, or broth, can soothe an irritated throat and thin any mucus.
• Use Honey: A spoonful of honey can help soothe the throat. It is an effective natural remedy for dry coughs, but should not be given to infants under one year old.
• Humidify the Air: Using a cool-mist humidifier or taking a steamy shower can add moisture to the air, which helps soothe dry airways.
• Gargle with Salt Water: Gargling with warm salt water can help soothe a scratchy throat and provide some relief.
• Use Lozenges: Sucking on cough drops or hard candies can stimulate saliva production, which helps moisten and soothe the throat.

ACE Inhibitors vs. ARBs: A Comparison for Cough

Feature	ACE Inhibitors (e.g., Lisinopril, Enalapril)	Angiotensin II Receptor Blockers (ARBs) (e.g., Losartan, Valsartan)
Mechanism of Action	Block the ACE enzyme, which prevents the conversion of angiotensin I to angiotensin II.	Block the binding of angiotensin II to its receptors.
Effect on Bradykinin	Prevents the breakdown of bradykinin, causing it to accumulate in the airways.	Does not interfere with the breakdown of bradykinin.
Incidence of Cough	High, affecting 5% to 35% of users.	Low, similar to placebo (around 3% or less).
Effectiveness	Highly effective for high blood pressure and other cardiovascular conditions.	Equally effective for high blood pressure and offers similar cardiovascular benefits.
Common Use	Often prescribed first due to historic availability and extensive research.	A standard alternative when ACE inhibitors are not tolerated, particularly due to cough.
Switching from ACEi	If a cough develops, trying a different ACE inhibitor is generally not effective, as the cough often returns.	No "washout" period is necessary; the switch can happen the next day.

Conclusion

A persistent, dry cough is a well-documented and often troubling side effect of ACE inhibitor medication for high blood pressure. The most reliable and effective solution is to work with your healthcare provider to switch to an alternative medication, such as an ARB, which offers similar benefits with a significantly lower risk of causing a cough. While home remedies can help manage the symptoms in the short term, they will not resolve the underlying issue. It is crucial to consult your doctor before making any changes to your medication regimen to ensure your blood pressure remains effectively managed and your overall health is prioritized.

What to Know About ACE Inhibitor Coughs

It's crucial never to discontinue an ACE inhibitor without consulting your doctor, especially since stopping the medication abruptly can worsen certain conditions. For more information on understanding this side effect, the AARP offers a helpful resource on ACE inhibitor coughs.

What to Know About ACE Inhibitor Coughs

Frequently Asked Questions

What kind of blood pressure medication causes a cough?

Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril and enalapril, are the class of blood pressure medications most commonly known to cause a persistent, dry cough.

How do I know if my cough is caused by my blood pressure medication?

The cough typically presents as a dry, tickly, and persistent sensation in the throat, and it does not produce phlegm. It can start anywhere from hours to months after beginning the medication. Your doctor can determine if the drug is the cause by having you temporarily stop taking it to see if the cough resolves.

What is the best medication to switch to if my ACE inhibitor causes a cough?

The most common and effective alternative is to switch to an Angiotensin II Receptor Blocker (ARB), such as losartan or valsartan. ARBs work differently and have a much lower incidence of causing a cough.

How long does it take for a cough to stop after switching blood pressure medication?

For most people, the cough will resolve within one to four weeks after stopping the ACE inhibitor. In some cases, it may take up to three months for the cough to completely disappear.

Can I use over-the-counter cough medicine to treat this cough?

Over-the-counter cough suppressants or remedies are unlikely to provide significant relief for an ACE inhibitor-induced cough because they do not address the underlying cause of the bradykinin buildup. Some home remedies like honey or a humidifier may offer temporary soothing.

Are there other types of blood pressure medications that don't cause a cough?

Yes, aside from ARBs, other classes of medication can be used, including calcium channel blockers (e.g., amlodipine), diuretics (e.g., hydrochlorothiazide), and certain beta-blockers.

Is an ACE inhibitor cough a dangerous side effect?

The cough itself is typically not dangerous, but it can be very bothersome and affect your quality of life. The danger lies in stopping your medication without medical guidance, which could cause a sudden and unsafe increase in blood pressure.