What medications make coughing worse?: A guide to drug-induced coughs

October 7, 2025 •

5 min read

Angiotensin-converting enzyme (ACE) inhibitors are the most common cause of drug-induced cough, affecting between 5% and 35% of patients. Understanding what medications make coughing worse is a crucial step in managing a persistent or chronic cough and improving your quality of life.

Quick Summary

Several classes of medications can cause or exacerbate a cough through various mechanisms, from accumulated chemical irritants to acid reflux. Drug-induced coughs are often dry, persistent, and require consultation with a healthcare provider to manage effectively.

Key Points

ACE Inhibitors are a primary cause: Medications ending in "-pril," like lisinopril and enalapril, are the most frequent cause of drug-induced cough due to the accumulation of bradykinin.
Drug-induced coughs are often dry: A characteristic of many medication-related coughs is their dry, non-productive nature, which may be accompanied by a tickling sensation in the throat.
Never stop medication abruptly: It is essential to consult your healthcare provider before stopping any prescribed medication to avoid serious health consequences.
ARBs are an alternative: For patients who cannot tolerate the cough from an ACE inhibitor, an angiotensin II receptor blocker (ARB) is a common and often better-tolerated alternative.
Asthma risk with beta-blockers and NSAIDs: Individuals with asthma may experience worsened coughing due to airway constriction from beta-blockers or an immune response to NSAIDs.
Resolution takes time: The cough caused by an ACE inhibitor typically resolves within 1 to 4 weeks after stopping the medication, though it can take up to 3 months.

Understanding Drug-Induced Coughs

When a cough develops after starting a new medication, it's important to consider that the drug itself might be the cause. While many factors can contribute to coughing, a drug-induced cough is an adverse side effect that can persist as long as the medication is taken. In most cases, the cough resolves a few weeks to months after the offending drug is discontinued under a doctor's supervision. Identifying the responsible medication is the key to effective treatment.

The Prime Suspect: ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are a class of medications widely prescribed for conditions like high blood pressure, heart failure, and chronic kidney disease. They are, by far, the most common drug class known to cause a persistent, dry cough. Common examples include lisinopril, enalapril, and ramipril, all of which end in “-pril”.

Why ACE inhibitors cause coughing

The cough is a direct side effect of how ACE inhibitors work. The enzyme ACE is responsible for converting angiotensin I to angiotensin II, but it also degrades other substances, including a protein called bradykinin. When ACE is inhibited by the medication, bradykinin and substance P accumulate in the respiratory tract. The buildup of these irritant chemicals sensitizes nerve fibers in the airways, triggering a persistent, scratchy, and non-productive cough.

Other Medication Culprits

While ACE inhibitors are the most common cause, other drugs can also make coughing worse or trigger a new cough. The mechanisms for these can differ, from airway constriction to aggravation of underlying conditions.

Angiotensin II Receptor Blockers (ARBs)

ARBs, such as losartan and valsartan, are often prescribed as an alternative to ACE inhibitors because they work similarly but do not affect bradykinin metabolism. Although the risk is significantly lower than with ACE inhibitors, a small percentage of patients (around 3%) may still develop a cough while taking ARBs.

Beta-Blockers

Beta-blockers, used to treat high blood pressure, heart rhythm problems, and heart failure, can induce or worsen coughing, especially in individuals with a history of asthma or other reversible obstructive lung disease. This is because some beta-blockers, particularly non-selective ones, can cause bronchoconstriction (tightening of the airways). Beta-blocker eye drops can also cause systemic effects, so patients should be aware of this potential side effect.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

In some people with asthma, taking NSAIDs like aspirin or ibuprofen can trigger bronchoconstriction, leading to coughing, wheezing, and other respiratory symptoms. This condition is known as aspirin-exacerbated respiratory disease (AERD). The reaction is not a true allergy but an immune-driven response that occurs in susceptible individuals.

Calcium Channel Blockers

Certain calcium channel blockers, such as amlodipine and verapamil, can relax the lower esophageal sphincter, increasing the risk of gastroesophageal reflux disease (GERD). A cough caused by GERD, often called a reflux cough, occurs when stomach acid irritates the esophagus.

Chemotherapy Drugs

Certain chemotherapy agents, including methotrexate and bleomycin, can cause lung toxicity, which may manifest as a dry, persistent cough. This side effect is more serious and requires careful medical evaluation.

How to Identify and Manage a Drug-Induced Cough

Identifying a drug-induced cough involves a process of elimination and communication with your doctor. Never stop a prescribed medication on your own without professional medical advice.

Steps for identifying and managing a cough:

Review Your Medication List: Look for new medications started around the time the cough began. This includes prescription drugs, over-the-counter medicines, and even supplements.
Consider Timing: A cough from an ACE inhibitor can start weeks to months after treatment begins. An NSAID-induced cough in a sensitive individual may occur within hours.
Discuss with Your Doctor: Your physician may suggest a "drug holiday"—temporarily stopping the suspected medication to see if the cough resolves. The cough typically subsides within 1 to 4 weeks of stopping the drug, though it can take up to 3 months in some cases.
Explore Alternatives: If the drug is confirmed to be the cause, your doctor can prescribe an alternative. For example, switching from an ACE inhibitor to an ARB is a common and effective strategy.
Consider Comorbidities: Patients with underlying conditions like asthma, heart failure, or GERD may be more susceptible to drug-induced coughs.

Comparison of Common Drug-Induced Coughs


Drug Class	Mechanism of Cough	Typical Onset	Cough Characteristics	Management Strategy	Alternative Options
ACE Inhibitors (e.g., Lisinopril, Enalapril)	Accumulation of bradykinin and substance P in airways.	Weeks to months after starting.	Dry, persistent, tickling sensation in the throat.	Discontinue drug under medical supervision.	Switch to an Angiotensin II Receptor Blocker (ARB).
ARBs (e.g., Losartan, Valsartan)	Unclear, much lower incidence than ACE inhibitors.	Can occur anytime, much less frequently than ACE inhibitors.	Generally dry, mild if it occurs.	Reassess if another cause is present.	Other classes of blood pressure medication.
Beta-Blockers (e.g., Propranolol, Metoprolol)	Bronchoconstriction, especially in individuals with asthma.	Can occur anytime, depends on patient sensitivity.	May be associated with wheezing or shortness of breath.	Use cardio-selective beta-blocker or avoid altogether in sensitive individuals.	Consider alternative heart medications.
NSAIDs (e.g., Aspirin, Ibuprofen)	Immune response leading to bronchoconstriction in sensitive asthmatics.	Within 30 minutes to 3 hours of ingestion.	Coughing, wheezing, nasal congestion.	Strict avoidance of NSAIDs.	Use acetaminophen for pain relief.
Calcium Channel Blockers (e.g., Amlodipine, Verapamil)	Relaxation of esophageal sphincter, causing GERD.	Can develop over time, correlated with meals or posture.	Chronic cough, sometimes without other reflux symptoms.	Discontinue or switch drug, manage GERD.	Alternative blood pressure or heart medications.

Conclusion

While a cough can stem from many causes, a thorough review of your medication history is a critical step in a differential diagnosis. The most common culprits include ACE inhibitors, but other classes like ARBs, beta-blockers, NSAIDs, and calcium channel blockers can also play a role through various mechanisms. If you suspect your cough is drug-induced, it is imperative to consult a healthcare professional. Do not abruptly stop taking any prescribed medication, especially those for serious conditions like hypertension or heart failure. Your doctor can help you safely identify the source of the cough and find an effective alternative treatment. For further reading, an in-depth review on identifying and managing drug-induced coughs can be found on the National Institutes of Health website.

Frequently Asked Questions

No, you should never stop taking a prescribed medication like an ACE inhibitor without first consulting your doctor. Abruptly stopping can be dangerous and worsen the underlying condition being treated. Your doctor can recommend a safe alternative.

A cough from an ACE inhibitor can develop within the first few weeks or months of starting the medication. In some cases, the onset can be delayed for up to six months.

Yes, Angiotensin II Receptor Blockers (ARBs) are a common alternative prescribed when an ACE inhibitor causes an intolerable cough. ARBs have a much lower risk of causing a cough because they don't affect the bradykinin pathway in the same way as ACE inhibitors.

Some inhaled pharmaceutical products can trigger a cough by stimulating cough receptors in the airways, especially in patients with bronchial hyper-reactivity. The formulation and type of inhaler can contribute to this effect.

While the respiratory effects of NSAIDs are most pronounced in sensitive individuals with asthma (AERD), they can potentially cause an exacerbation of underlying respiratory conditions. However, NSAID-induced cough is generally less common in those without a history of asthma.

A doctor can help determine if a cough is drug-induced by performing a "challenge/rechallenge" test. This involves stopping the suspected drug to see if the cough resolves and then, if safe, reintroducing it to see if the cough returns. Other medical causes must be ruled out as well.

Certain calcium channel blockers can cause coughing by relaxing the lower esophageal sphincter, which leads to gastroesophageal reflux disease (GERD). The acid from the stomach then irritates the esophagus, triggering a cough, even if you don't feel other classic heartburn symptoms.