Is a Dry Cough a Side Effect of Losartan? A Pharmacological Comparison

October 13, 2025 •

3 min read

Factually, losartan is significantly less likely to cause a dry cough than its predecessor drug class, ACE inhibitors. In fact, it is often prescribed as an alternative specifically to manage a bothersome ACE inhibitor-induced cough. Still, is a dry cough a side effect of losartan? The answer is it's possible, though uncommon.

Quick Summary

Losartan, an ARB, has a much lower incidence of dry cough compared to ACE inhibitors like lisinopril due to a different mechanism of action. A cough is a rare side effect, but can occur. Individual reactions and previous ACE inhibitor use can influence the risk.

Key Points

Losartan is an ARB, not an ACE inhibitor: Losartan does not cause the same buildup of bradykinin as ACE inhibitors, which is why it's less likely to cause a cough.
Lower, but not zero, risk of cough: Losartan has a very small risk of causing a dry cough, significantly lower than ACE inhibitors.
Cough after switching is often 'carry-over': A cough after switching from an ACE inhibitor to losartan may be a residual effect.
Alternatives are available for persistent cough: Options like calcium channel blockers or diuretics may be considered for a bothersome cough on losartan.
Consult a doctor for evaluation: Do not stop taking losartan without consulting a doctor to investigate a persistent cough.
Individual sensitivity varies: Some patients may have a unique response to losartan.
Losartan is often used to resolve ACE inhibitor cough: Losartan is a preferred alternative for those with an ACE inhibitor cough.

Losartan vs. ACE Inhibitors: The Key Difference

Losartan is an angiotensin II receptor blocker (ARB), while lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. Both target the renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure. However, their distinct mechanisms lead to differences in side effects, particularly cough.

ACE inhibitors block the enzyme that converts angiotensin I to angiotensin II. This enzyme, also called kininase II, also breaks down bradykinin. By blocking this enzyme, ACE inhibitors cause bradykinin to accumulate in the lungs and airways, leading to a dry cough in 5% to 35% of patients.

Losartan, as an ARB, blocks angiotensin II from binding to its receptors. Since it does not inhibit the ACE enzyme, it doesn't cause the same bradykinin buildup, resulting in a much lower incidence of dry cough.

Is Cough with Losartan Possible?

A dry cough with losartan is rare but can occur. Studies have shown that even patients who experienced an ACE inhibitor cough have a similar cough rate on losartan as those taking a placebo. Possible reasons for a cough while on losartan include individual sensitivity, a "carry-over" effect from previous ACE inhibitor use, pre-existing respiratory conditions, or in very rare cases, a reaction directly linked to losartan itself.

Managing a Cough on Losartan

If you develop a persistent dry cough on losartan, consult your healthcare provider. Do not stop taking the medication without their guidance. Your doctor will assess the cause and determine the appropriate steps, which may include observation, considering alternative medications like calcium channel blockers or diuretics, or investigating other potential causes of the cough.

Comparison of Losartan (ARB) and Lisinopril (ACE Inhibitor)


Feature	Losartan (ARB)	Lisinopril (ACE Inhibitor)
Mechanism of Action	Blocks the angiotensin II receptor, preventing vasoconstriction and aldosterone release.	Blocks the ACE enzyme, preventing angiotensin II formation AND bradykinin breakdown.
Incidence of Cough	Low (less than 1% to low single digits in some studies).	High (5-35% of patients).
Reason for Cough	Not fully understood, but not related to bradykinin accumulation.	Caused by bradykinin accumulation in the airways.
Onset of Cough	Can occur anytime, but is rare. May have a "carry-over" effect from previous ACEI use.	Typically develops weeks to months after starting the medication.
Resolution	Usually resolves upon discontinuation of the drug.	Discontinuation of the drug typically resolves the cough within 1-4 weeks.
Use in ACEI Cough	Often prescribed as an alternative for patients with ACE inhibitor-induced cough.	Not used for patients who develop cough on another ACE inhibitor, as the effect is a class-wide issue.

Conclusion

Losartan and other ARBs are a preferred alternative for patients concerned about the dry cough associated with ACE inhibitors. Their different mechanisms of action explain losartan's significantly lower risk of this side effect. While a cough on losartan is rare, it is possible, and any persistent symptoms should be discussed with your healthcare provider to ensure the best treatment plan.

This article is for informational purposes only and does not constitute medical advice. Consult a healthcare professional for diagnosis and treatment. You can learn more about losartan's side effects and mechanisms on the NCBI Bookshelf {Link: NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK526065/}.

Other Common Side Effects of Losartan

Beyond the rare possibility of a cough, losartan has other potential side effects that are generally mild. These can include dizziness, fatigue, nasal congestion, back or muscle pain, diarrhea, headache, and upper respiratory infection. More serious but uncommon side effects include high potassium, angioedema, kidney problems, and severe allergic reactions.

Final Takeaway

Losartan is a good option for many patients, especially those who experience a cough with ACE inhibitors. Always discuss your health history and any side effects with your healthcare team for optimal treatment outcomes.

Frequently Asked Questions

While a dry cough from losartan is not typically serious, discuss any persistent side effect with your doctor. Serious issues like angioedema are rare but need immediate attention.

If the cough is caused by losartan, it usually subsides within a few weeks after stopping the medication.

An ACE inhibitor cough is due to bradykinin buildup. Losartan, an ARB, doesn't affect this and is much less likely to cause a cough; if one occurs with losartan, it's typically not related to bradykinin.

Switching from an ACE inhibitor like lisinopril to an ARB like losartan is a common strategy to resolve a cough. Always do this under a doctor's supervision.

Yes, other classes like calcium channel blockers or diuretics typically do not cause a cough.

Contact your healthcare provider. They can determine the cause and if an alternative treatment is needed. Do not stop medication without their guidance.

Common side effects include dizziness, fatigue, upper respiratory infection, stuffy nose, back pain, and headache.

Do not take OTC cough medication without consulting your doctor, as it might interact with losartan or raise blood pressure. Addressing the cause is best.