Which Drug Causes Hoarseness of Voice? A Comprehensive Pharmacological Guide

October 11, 2025 •

3 min read

According to some medical surveys, inhaled corticosteroid therapy for asthma has shown a dysphonia incidence that varies from 5% to 58%, making it one of the most common causes of medication-related voice problems. Understanding which drug causes hoarseness of voice is crucial for patients, as many common prescriptions and over-the-counter drugs can affect vocal quality through different mechanisms.

Quick Summary

This article explores common medications that can cause hoarseness by affecting vocal cord lubrication, muscle function, and inflammation. It covers drug classes like inhaled steroids, ACE inhibitors, antihistamines, and hormonal therapies, explaining the underlying mechanisms and potential management strategies.

Key Points

Inhaled Steroids are a Common Cause: Asthma medications like inhaled corticosteroids are known to cause dysphonia, or hoarseness, in many patients due to vocal cord irritation and myopathy.
ACE Inhibitors Can Cause Hoarseness through Cough: Blood pressure medications like lisinopril can trigger a persistent dry cough, which can damage vocal cords over time and lead to hoarseness.
Dryness Impairs Vocal Cord Function: Antihistamines, diuretics, and some antidepressants cause dehydration and dryness, preventing the vocal cords from vibrating efficiently and causing hoarseness.
Hormonal Therapies Can Cause Irreversible Changes: Testosterone and other androgenic hormones can permanently thicken vocal cords and deepen the voice, especially in women.
Always Consult a Doctor: If you experience hoarseness, never stop a medication on your own. Discuss the issue with your prescribing physician to explore alternatives or management strategies.

Understanding Medication-Induced Dysphonia

Hoarseness, or dysphonia, is a common side effect of many medications, impacting millions of people globally. Medications can cause hoarseness in several ways, including drying the vocal cords, irritating laryngeal tissue, causing fluid retention, or affecting muscle control. Vocal cords require proper lubrication to vibrate efficiently and produce a clear voice.

How Medications Affect Vocal Function

Different drug classes impact the voice through distinct pharmacological pathways, including drying effects on mucous membranes, local irritation, vocal cord muscle weakness, cough-induced trauma, hormonal changes, increased bleeding risk, and neurological effects.

Common Drug Classes Causing Hoarseness

Inhaled Corticosteroids (ICS)

Inhaled corticosteroids, used for asthma and COPD, are a significant cause of drug-induced hoarseness. This can be due to local irritation, vocal fold myopathy, or oral thrush from drug deposition in the throat. Examples include fluticasone, beclomethasone, and budesonide.

ACE Inhibitors

ACE inhibitors, such as lisinopril and enalapril, are blood pressure medications known for causing a persistent dry cough. This chronic cough can lead to vocal cord injury and hoarseness. The cough is linked to the buildup of inflammatory substances like bradykinin, and switching to an ARB may resolve the issue.

Dehydrating Medications

Several medications can cause dryness that affects the vocal cords, including antihistamines (e.g., diphenhydramine, loratadine), diuretics (e.g., hydrochlorothiazide, furosemide), and decongestants (e.g., pseudoephedrine). Tricyclic antidepressants like amitriptyline can also have a drying effect.

Hormonal Drugs

Androgen/testosterone therapy can cause irreversible vocal cord thickening and voice deepening. Oral contraceptives containing estrogen may lead to vocal cord fluid retention and a lower-pitched voice.

Medications That Exacerbate Reflux

Some drugs can relax the esophageal sphincter, contributing to laryngopharyngeal reflux, which irritates the larynx and causes hoarseness. Muscle relaxants and bisphosphonates are examples.

Other Notable Offenders

Other medications that can cause hoarseness include anticoagulants, which increase the risk of vocal cord bleeding, central nervous system depressants affecting speech coordination, and oral retinoids causing dryness.

Comparison of Drugs That Cause Hoarseness


Drug Class	Examples	Mechanism for Hoarseness	Potential Management
Inhaled Corticosteroids (ICS)	Fluticasone, Budesonide	Direct irritation, vocal cord myopathy, oral candidiasis	Use a spacer, rinse and gargle after use, lowest effective dose
ACE Inhibitors	Lisinopril, Enalapril	Chronic dry cough leading to vocal cord lesions	Switch to an Angiotensin II Receptor Blocker (ARB)
Antihistamines & Decongestants	Diphenhydramine, Pseudoephedrine	Drying effect on mucous membranes, impairing vocal cord lubrication	Maintain hydration, limit use, use newer, less-drying antihistamines
Diuretics	Hydrochlorothiazide, Furosemide	General dehydration, drying vocal cord mucosa	Increase fluid intake, but do not stop medication without doctor consultation
Testosterone	Depo-Testosterone, AndroGel	Thickening of vocal cords (irreversible)	Changes are often permanent; consider prior discussion of risks
Anticoagulants	Warfarin	Increased risk of vocal cord hemorrhage or polyps from trauma	Vocal rest during episodes, proper vocal hygiene

Managing Medication-Induced Hoarseness

If you suspect a medication is affecting your voice, consult your doctor or an ENT specialist. Do not stop or change medication without medical supervision.

Management strategies include:

Staying well-hydrated.
Using a spacer and rinsing with water after using inhaled steroids.
Practicing good voice hygiene by avoiding vocal abuse like shouting or excessive throat clearing. Whispering should also be avoided.
Using a humidifier.
Discussing alternative medications with your doctor, such as switching from an ACE inhibitor to an ARB.
Considering voice therapy with a speech-language pathologist for persistent changes.

Conclusion

Various medications, particularly inhaled corticosteroids and ACE inhibitors, can cause hoarseness through different mechanisms. Dehydration and hormonal changes are also common factors. If you experience persistent voice changes, consult your doctor to discuss potential adjustments or management techniques and protect your vocal health.

Visit MedShadow Foundation for more information on medications that can affect the voice.

Frequently Asked Questions

Yes, many over-the-counter medications, particularly antihistamines and decongestants for colds and allergies, can cause hoarseness by drying out the mucous membranes of the throat and vocal cords.

To prevent hoarseness from inhaled steroids, it is recommended to use the lowest effective dose, use a spacer device, and rinse and gargle your mouth with water immediately after each use to minimize local deposition of the drug.

Hoarseness caused by most medications is not permanent and typically resolves after discontinuing the drug. However, voice changes caused by androgenic hormones are often irreversible.

If you experience a persistent cough and hoarseness from an ACE inhibitor, consult your doctor. They may switch you to an alternative medication class, such as an angiotensin II receptor blocker (ARB), which is less likely to cause a cough.

Yes, staying well-hydrated is a fundamental step in managing medication-induced hoarseness, especially when caused by dehydrating drugs. Proper hydration helps lubricate the vocal cords for smoother vibration.

Voice therapy with a speech-language pathologist can be very effective for managing hoarseness. They can teach you exercises and techniques to reduce vocal strain and improve vocal quality.

Anticoagulants, or blood thinners, increase the risk of bleeding. The small, delicate blood vessels in the vocal cords are more prone to hemorrhage (bruising) or polyp formation from vocal trauma, which can cause hoarseness.