When Will Doctors Pay Attention to an ACE Cough?

In this country doctors like to prescribe medicines (many without knowledge of their serious side effects) Not like in Europe, there are more careful prescribing drugs -may be because they don't get any benefits from the drug companies.? - I notice this here in the US, several of my doctors prescribing medication BEFORE they find out that I really needed them.

I am one of the fortunate ones. My doctor prescribed one of these drugs a few years ago. This ghastly cough began right away and I went back and told him that when I stopped taking it, the cough disappeared and please prescribe something else. He responded, "Oh yes, that is a common side effect!" I had guessed it immediately, and he was aware of the problem. Whew!

I too have a cough. I take Diovan which is not on your list, but is also an ACE inhibitor. Been taking it for a couple of years. It starts as a tickle and becomes a cough. Used to take Monopril which caused the same thing.

It is incredible to me that physicians don't think FIRST about B/P meds when presented with a troublesome cough. It's the first question I ask someone when they complain about one. And it would be the easiest and cheapest cause to treat. I wonder sometimes if that's why they don't.

I have an elderly friend whose cough I feel with some certainty is related to her B/P med. At my urging, she dutifully asked her doctor, who said it wasn't. I dutifully shut up, because I don't like to undermine people's confidence in their doc, and also don't like second-guessing them with insufficient information. Several tests and scopes later, she was given a diagnosis that is not specific, and inhaler meds.

I would have had more confidence in the guy had he changed her B/P med just to see. If she were my mother, or had she asked me to be more involved, I would have insisted, or sought a different doc.

Not only did I start to get a cough but after 14 days on Lisinopril at the smallest dose, my legs started aching, burning and throbbing. They became so weak I could hardly stand. Once I connected the dots I stopped the medication but the effect didn't go away. It took weeks for the aching to subside and the weakness and ache was almost impossible to live with. Acupuncture helped but I have had to repeat the sessions about every six months just to stay standing.

No the drug did NOT lower my BP either. I've tried three meds and all of them gave me terrible adverse effects. I have added natural supplements and my pressure is now great!

After suffering horrific effects from blood pressure medication (an eight-year bout with lupus that turned out to be caused by Apresoline (hydralizine), I was switched to Vasotec. The lupus subsided and my blood pressure was perfectly controlled. I did develop the ACE inhibitor cough. I was never without sugar-free lozenges in my pocket and by my bedside.

Then my health-care provider switched me from Vasotec to lisinopril hctz (it is MUCH
cheaper). And my cough completely disappeared. My blood pressure has stayed stable (115/70) for the last five years on lisinopril hctz; the cough is completely gone. The prescription costs me $20.00 per year. That's right: twenty dollars!

I guess this just means that everyone is different.

She is correct, Lisinopril caused a horrible cough that I put up with for a over a year -- couldn't take it anymore, I'm on a better medicine and cough off and on, not all the time, Norvasc. I'm having a constant runny nose, not sure if this is the cause. Does anyone have that problem? I also think it could be from using face creams and makeup.

Ruth W.,

Diovan is NOT an ACE Inhibitor, but an ARB (angiotensin receptor blocker). ARB's like Diovan and Cozaar ARE NOT associated with a cough like ACE Inhibitors are.

The above summary is also not correct; it was suggested that if lisinopril caused a cough switching to ramapril would offer no benefit, this exact situation is often helpful.

Sometimes it is necessary to take an ACE Inhibitor even if it causes a cough. Compared to all the benefits of ACE Inhibitors a cough is often an annoying side-effect that must be put up with.

PEOPLE'S PHARMACY RESPONSE: COUGH IS MUCH LESS COMMON WITH ARBS, BUT IT DOES TROUBLE A FEW PATIENTS. PLEASE TALK WITH YOUR DOCTOR ABOUT THE COUGH.

My husband & I both take BP meds and both coughed a lot.
The culprit was:
Enalapril 20mg, manufactured by TEVA.
When the doctor changed the prescription to:
Enalapril 20mg, Tab APA, NABP: 1528910

The cough stopped completely and our blood pressure was controlled to & below the accepted standards. It seems that the manufacturers used different ingredients.

Jand,

I'm glad to here that your cough has gone away. It is not likely that changing the manufacturer was the real solution, as a cough is possible with all ACE Inhibitors.

Sometimes the cough will just go away. Sometimes a stopping the medication and re-starting can stop the cough too.

A NABP number is a National Boards of Pharmacy number and is unique for each pharmacy, not for each medication.

All I know is when I got my prescription filled thru MEDCO, I coughed all the time and when I got it filled at Wal-mart the coughing stopped. My husband had his filled at Wal-mart for a long time & when he changed to MEDCO his coughing started. When he changed back to Wal-mart the coughing stopped. Thanks for the info on the numbers.

Jand,

Thank you for sharing your experiences. It really helps me as a future pharmacist. Just because a medication isn't "supposed to" do something or have a side-effect doesn't mean it isn't the cause of the problem.

Respectfully,

Greg, now Doctor of Pharmacy :)

Diovan is NOT an ACE inhibitor . It is in the class called Angiotension receptor blockers, ARBS. Developing a cough while using this is possible but not a common side effect at all. I would have this cough checked out as there may be another reason for your cough.

I was prescribed Lisinopril a couple of years ago. My doctor warned me initially about the cough and asked me to let her know if I developed it. After being on the medication for about six weeks, I started coughing. I would normally start coughing about 4 in the afternoon. It would become progressively worse as the day went on. I could not sleep from the constant coughing. Cough suppressants soothed my raw throat some but had no affect on the cough.

At my next appointment, I told my doctor what was going on. She said, "No, this cough is not from the medicine."

I discontinued the medicine because I would rather take my chances with HBP than live with the cough. I'm not sure how my blood pressure is doing, but I am cough free since I quit the Lisinopril.

PEOPLE'S PHARMACY RESPONSE: IT IS NOT A GOOD IDEA TO IGNORE HIGH BLOOD PRESSURE, AS IT COULD LEAD TO A STROKE OR HEART ATTACK. PLEASE DO CHECK IN WITH YOUR DOCTOR AGAIN AND REQUEST A DRUG THAT WILL NOT MAKE YOU COUGH. THERE ARE PLENTY.

I don't understand why my dr. has prescribed LISINOPRIL when I DO NOT HAVE HBP, I do have high triglycerides, she is worry about my heart because I am diabetic. Is this drug used also for triglycerides? I am afraid to use it, with all the potential negative side effects. Can I take something else that has less problems and is more natural?

CPMT,

You likely were prescribed Lisinopril at a low dose, that will not lower your blood pressure that much.

This IS NOT for your triglycerides. But your diabetes and triglycerides are connected. You should control both. By controlling diabetes your triglycerides should improve.

Your doctor has you on Lisinopril to protect your kidneys. Drugs ARE bad, but having diabetes and kidney failure is MUCH worse.

Most people have NO problems with Lisinopril. This website makes side-effects seem like more of a problem than they are for most people.

Please take your Lisinopril.

My doctor suggested that I take Lisinopril to lower my BP from 135/85 to the recommended 120/80. Well, exactly one hour after a single 10mg dose my BP had indeed dropped to 121/76, but a relentless dry cough started simultaneously. I stayed up all night coughing so hard that I threw up twice. I was worthless at work the next two days and then developed a severe headache and sinus pressure. I did not take a second dose.

The lower BP isn't worth it. In fact I've proven that I can lower it as much with 10 minutes of Pranayama. OTC cough medicine helped for about 20 minutes; clover honey and whiskey before trying to go to sleep works as well and tastes much better.

This cough was not an annoying side effect that must be put up with!! It was debilitating and simply intolerable. Under no circumstances would I consider it a necessity to take this drug. If the sort of cough I had 5 days ago had continued a few more days with no relief I would have ended my life. I am completely serious. Four years ago I had retching hiccups for a full week and felt the same way -- it had to stop. A brilliant PA prescribed a very low dose of thorazine, which worked.

I saw one of my doctor's PA's three days after the cough started and her response after consulting with my doc was to prescribe another BP med - an ARB. "If the cough persists it must be something else. Come back if it doesn't stop." I still haven't decided if I'll take the ARB when the cough finally subsides. But I will have a conversation with my pharmacist. And I think it may be time to find another doctor.

Your doctor is not your boss. She or he is presumably the informed person giving you sound advice. It's your life and your decision whether to accept that advice or not. I'm not convinced that the benefits of 120/80 BP vs 135/85 are worth the risks of more experimentation.

If your doctor tells you that the ACE drug can't be causing your cough, get up and walk out of the office. You and your insurance company should not have to pay for that office visit. There are many other medications and life style possibilities for lowering BP and many other doctors.

Ken,

You make a lot of good points. It seems for you, Lisinopril was not the right choice. You should play a role in your own health care; most doctors would agree. (It's less work for the doctor if you are active in your health care.)

ARBs don't seem to cause a cough in as many people as people on Lisinopril.

Losing weight and avoiding salt in foods are both great ways to lower blood pressure.

Avoid salt and extra fat by starting to read nutrition labels on the foods you eat.

Thanks for your comments Greg,

Managing a chronic condition like high BP simply can't be successful with a magic pill, an office visit every few months and you do whatever you want in between. I never take a new medication without asking both the doctor and pharmacist about side effects and interactions with other drugs, foods and vitamin supplements. I weigh 150lbs, cycle 150mi/week, practice yoga and have been avoiding high sodium foods for years. Almost all restaurants are agreeable to preparing meals without seasoning or at least have reasonable alternatives.

I'm reluctantly to start another medication with dry cough as a side effect until the cough I have now is completely gone.

In the last month I've found that if I check my BP after 5 to 10 minutes of pranayama (controlled breathing) it is much lower -- as low as 114/71. I sit upright in a comfortable position, close my eyes and breathe deeply and slowly but without strain or effort. Equal length inhalations and exhalations of about 10 seconds each works best for me. So 3 breaths per minute, but it has to be sustainable rate. My BP is also consistently lower after vigorous exercise.

I think the mental health aspects (stress, anxiety, depression, ...) of high BP should receive more attention. Regular sessions with a counselor may be the most appropriate prescription.

I was switched from diovan (out of pocket$$$ got too much $84.99) to lisinopril $4.00.(I am taking 1/2 of a 20mg tablet); My First dose was April 28, 2010. I woke up the next morning and the coughing started. (My family Dr. had said, yes, there was coughing as side effect but only lasted a short time.) The second week of May, I caught a virus going around with high fever and COUGHING so I took the meds and cough syrup with codeine and only THAT stopped my cough; I was actually experiencing two conditions at the same time, I guess. After I got better and the fever went away, I was still coughing; gut wrenching coughing with incontinence; that IS the worst part.

Now, here it is June 21, 2010 and I still have gut wrenching coughing; I WOKE up this morning and it felt like something was STUCK in my throat; and it makes talking sound hoarse, too. It starts all of a sudden; in my throat feels like a tarantula or something horrid is crawling around in there, scratching!!! then my eyes water and gush tears and the coughing fit starts; yesterday afternoon I had one that lasted 10 minutes! (husband told me); this is horrid; it has been almost two months!

HOW long before the coughing "goes away"??? When I was switched from Diovan (to save money) I put away 89 Diovan tablets ; I am tempted to start them and stop the lisinopril and see what happens; but, my Dr will probably think it is psychological!

s.h.,

I have empathy for how you feel. I've had a dry cough since June 7th when I took my one and only dose of Lisinopril. It is much better now, but a couple of times a day it comes back and it's miserable for me and anyone nearby.

If the only reason you switched from Diovan was the expense then I see no reason not to take the remaining tablets that you paid for. And go back to your doctor. If your complaints are dismissed as "psychological" and he or she refuses to prescribe another medication, then find another doctor. There are many BP meds and treatments. Your cough is real no matter what the cause is and you deserve relief.

Like everyone else here I developed a horrible cough. Driving during an episode was horrible. I would gag (and a couple of times - vomit) I remembered one of the possible side effects for the lisinopril was a dry cough. I looked it up today, found this website and called my doctor to switch to a different type of blood pressure medicine.

It is Amlodipine Besylate I hope this one is better. I did want to note that I have never been on medication before and I did read through the warnings that came with it. Dry cough was definitely listed and it said to contact a doctor if it became distressful.

I have taken METOPROLOL TART 25mg for 6 months before I coughed. I gag, vomit clear mucus, my eyes run like water is pouring out, I get shortness of breath and I had to ride on an airplane recently. I was so embarrassed I know people thought I had a bad cold. I finally got to the family reunion and my cousins told me to stop taking the medicine.

One cousin said she had the same problem and stopped taking the meds. My sister says she has to keep sucking cough drops. I tried cough drops It does not help. My doctor told me I have an allergy. I am going to have to put my foot down with my doctor and demand another type of medicine.

I have printed out symptoms of other people to take to the doctor to show her that everyone can't be wrong.I advise every one to do the same thing, print it out.

I started taking Lisnopril in 2009 and my doctor at that time warned me of the possible side effect of a dry cough. After about 2 months the coughing started. It was not too bad until it gradually worsened and achieved a level where it interfered with my life (and those around me). It did control the BP nicely so I was reluctant to switch, but did tell my physician. He then switched me to Amlodipine Besylate. It took about 3 months to work as well on controlling the BP. He encouraged me to wait and see...... and now, no coughing. I don't seem to notice any other side effects either.

The article was about the ACE cough but that is the least of my worries. After 2 weeks on 10mg Lisinopril I started having episodes of a severely pounding heart alternating with periods of strong anxiety attacks. I put up with it for a week before stopping the drug. The problems continued for weeks after, and may be still happening at a much lower level today!

The scary thing was that my bp skyrocketed! 7 weeks after stopping I hit 191/110 with a pulse of 104. Now with a new doctor I have been on a beta blocker, a beta blocker with low dose ACE, the low dose ACE alone, a low dose calcium channel blocker and a higher dose calcium channel blocker. My bp is barely controlled while the side effects like anxiety, muscle aches and abdominal discomfort are constant and almost debilitating.

I've been so tired that I've nearly fallen asleep driving! The medical community needs to put effort into finding why bp changes. It doesn't go up or down on its' own. I wonder how many years I've lost due to the damage done by these drugs.

What Over the Counter drugs can a diabetic take for cough?

PEOPLE'S PHARMACY RESPONSE: MOST OF THE OTC COUGH MEDICINES CONTAIN EITHER MENTHOL OR DEXTROMETHORPHAN. DM IS VERY BITTER, SO THEY USUALLY SWEETEN THOSE QUITE A BIT.

WHY NOT TRY THYME TEA? 1/2 TSP THYME STEEPED 5 MIN IN A CUP OF BOILED WATER. NO SUGAR, NO EFFECT ON BLOOD SUGAR, OFTEN (NOT ALWAYS) HELPS COUGH

Shirley C.

There is a product called Diabetic Tussin that is sold in most stores.

Most cough syrups have sugar in them; diabetics tend to avoid excess sugar. However if you are a diabetic you know that sugar is not banned from your diet, so any cough product is acceptable to take.

Tablets for cough like the Coricidin would avoid much of the sugar in syrups.

There are no cough preparations that severally affect diabetics because of medications they are on or diabetes itself.

An ACE-i is the FIRST antihypertensive drug to try in MOST cases (especially to protect the kidneys). There are many generic ACE-i on the market--and that is why so many MD's prescribe it as a first line drug. If a person does develop an ACE-i cough (or other bothersome side effects), it is perfectly reasonable to replace the ACE-i with something else--such as an 'ARB' It used to be that the only ARBs available were in brand name form.

Recently, however, losartan potassium is available, which is generic and insurance companies are not balking at the price anymore. An ARB also has properties that spare the kidneys damage.

It is worth mentioning to your MD--but she has the entire picture of your health, and that is a decision to be made between the both of you.
Best of Health!

My doctor changed my prescription from Enalapril (again) to Tekturna 300mg. I took it for 3 months and developed the most horrendous deep, eruptive cough. I thought it was whooping cough; had a chest x-ray and and my lungs were clear. So he changed my prescription back to Enalapril 20mg 2XD, which I obtained at Wal-mart, and my cough is disappearing. I will not allow him to change my meds again. I would rather have the high BP than have the cough.

I, too, have The cough after 2 months on Lisinopril. I now, 2 months later. have muscle aching and foot and leg cramps. I started with curry daily and it has brought down my BP by 20 points to 120/80 and I am now looking for other natural ways to keep it down so I can get off my meds. Which supplements did you find most useful? Thank you for any additional information.

I took Lisinopril for one year with no problem--it was cheap and it worked. I developed a dreadful cough in August. I wasn't sick with a cold, didn't feel bad, had never had allergies, I just had a horrific dry cough. I happened to see my cardiologist socially in October and mentioned the cough, but never suspecting the Lisinopril. He immediately asked which meds he had me on and said to stop taking the Lisinopril immediately, that he would change the meds--that the Lisinopril was causing the cough.

It took 3 1/2 weeks, but thankfully the dreaded cough is gone. Evidently the "pril" drugs are supposed to be the ones that cause the cough.

Diovan is NOT an ace inhibitor. It has a similar mechanism of action, affecting angiotensin, but typically does not have the same side effects as an ace, and it is common practice to substitute an angiotensin II receptor blocker like Diovan for an ace like lisinopril because of that very reason. This is not to say that it is impossible that it caused a cough though.

Anyone notice hair loss, itchy eyes and scalp?

I couldn't believe that no one mentioned the fact that Lisonopril will also make your hair fall out. It was my only medication and it worked well for the B/P but after a few months, my hair started falling out. I stopped the Lisonpril and the hair has stopped falling out but has not grown back in yet. (about 2 months) Could be a coincidence but I don't think so.

What natural supplements worked for your blood pressure and were they in addition to any other drug for blood pressure?

Thanks!

I have just been switched from Lisonopril to a calcium channel blocker because I have developed a cough that was totally debilitating. I still have the cough after 2 weeks of switching and my doctor is going to watch to see if it subsides. I stopped going to church and getting my hair done and most social activities because when the cough comes on everyday I go into a "fit" of coughing that will not stop until I cough so hard I sometimes throw up. I am exhausted and praying for an end to living like this.

I am prediabetic, take simvastatin and b/p meds and unable to walk anymore. Having awful time with dry skin flaking every time I scratch the itch, especially legs and some parts of the arms. Notice small bumps on the legs and feet which may be my age (83) but before my blood sugar was so high, never noticed especially dry flaky skin. Is it from the high blood sugar? Or could it be circulation problems from being sedentary. Have had polio hit me at 25 yrs age, then much later, post polio started weakening me again. Could poor circulation cause this dry scaly flaky skin?

PEOPLE'S PHARMACY RESPONSE: POOR CIRCULATION MIGHT CAUSE DRY FLAKY SKIN. BE SURE TO USE A STRONG MOISTURIZER EVERY DAY. IF IT IS NOT SIMPLY DRY SKIN, IT IS POSSIBLE THAT THE HIGH BLOOD SUGAR IS CONTRIBUTING TO YEAST OVERGROWTH THAT LEADS TO ITCHING AND FLAKES. IF YOU CAN LOWER IT, SEE IF THAT HELPS. IT MAY TAKE A COUPLE OF WEEKS.

I too have had very violent reactions to many ACE inhibitors (like the cough among other problems) and CC blockers and one or more other types. I am now on acebutolol (it's cheap too) and all my problems went away. What is needed here, and what I have done, is to make sure that when you go to the doctor and you are first interviewed by the nurse, make sure you tell her about your reaction to the particular drug you have problems with.

This will get their attention to be sure.
Good luck.

I took 2 different ACE drugs, developed the cough which was worse at night, would wake up coughing. The MD switched my to an ARB-Lotensin for the next 6 months, felt like I had swelling or lump in the back of my throat and a dry cough during the day and night although not as severe. It was during the winter season, thought it was something else.

I went back to the doctor asked to be switched to HCTZ. Gee every symptom went away. But it took some convincing the MD. I wish that physicians/pharmacist would listen more carefully to patients. They are not always correct and not every patient will fit into the cookie cutter mold of side effects that are published by the drug manufactures for their selling capabilities.

My grandmother (86) was recently hospitalized, and the hospital doctor switched out ALL her medications and added a few more. She now takes Diovan, Amlodipine, Metoprolol, Haloperidol, Celexa and low dose aspirin. Since taking the new medications, she has had the awful coughing with watering eyes and runny nose, muscle weakness, confusion, and her hands shake. The doctor reduced the Haldol from 3x a day to twice a day which reduced the confusion, but she still has the deep choking cough and muscle weakness.

I just realized after months that my cough (thought it was allergies) was caused by an increase in my Benazepril prescription.... going to ask my Dr. to change my medication. Meanwhile, I have found Listerine strips VERY helpful in controlling my cough... have them by my bedside and insert one on the back of my tongue when a coughing fit occurs!

I also got a terrible cough on an ACE, Trandolopril.
I switched to Diovan (an ARB ) which sent me to the ER with a HR of 200 and chest pain.

I was then switched to Verapamil and Benicar (also an ARB) I have been taking these for 3 years. I have now all of a sudden developed the EXACT same throat "tickle" that I had on the ACE inhibitors and non-stop coughing that is intolerable (on the Benicar.) I also have a continuous runny nose.

A listed side effect of ARBs is chronic bronchitis and runny nose. You can also develop a cough with an ARB tho it is "less likely" but it does happen. Don't let anyone tell you it doesn't.

I am on BP med and I hate it.
I have tried vits, minerals but didn't have good results. What are you taking the help you? I know you are not a DR. and I am not going to stop my meds cold. But I want to talk to my DR. about some other alternatives. Thank you Michelle.

1-I always warn my patients that they may develop a cough when you start an ACE inhibitor. 10% of the time it will cause a cough

2-We use ACE inhibitors a lot because they happen to SAVE LIVES! PERIOD! They are also dirt cheap.

3-Most coughs are due to post sinus drainge which can be difficult to prove and treat

4-If you want to get treated "all naturally" then see a homeopath and don't waste my time. When you come to me and ask for that kind of treatment, it's like going to a cabinet maker and asking him to tile your bathroom. That's not the kind of work I do! Some MDs do a lot with homepathic remedies because it's avant garde and it makes a lot of money - it's all cash and insurance won't pay for it - and you suckers fall for it hook line and sinker.

5-If you don't like my advice then go somewhere else - I have way more than enough work on my hands with people who are willing to work with me on their medical care and not complain about it on a blog behind my back!

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PEOPLE'S PHARMACY RESPONSE:

Dear Doc,

We appreciate your candor about ACE inhibitors like lisinopril and ramipril. The actual incidence of cough remains somewhat controversial. That may be because clinical trials are not as good as we would like when it comes to picking up adverse reactions. Even at 10 percent, though, that is a LOT of coughing.

If you check the various threads on this website about ACEIs and cough you will discover how terribly disruptive it can be for people. It can:

1) Keep them awake at night
2) Lead to vomiting
3) Lead to incontinence
4) Destroy the quality of their lives.

You may warn your patients in advance...but surprisingly, many of your colleagues do not warn their patients. And when people start complaining about coughing, they are not infrequently referred to allergists and worked up for everything under the sun without having their prescription changed. That seems like bad medicine to us. Your thoughts?

"Homeopathy" has become a catch-all term for anything alternative or "natural." If you are lumping the DASH diet, exercise, weight loss, meditation, yoga, deep breathing, biofeedback and dietary interventions (beet juice for example) into that basket and dismissing it out of hand, we think you are missing out on an opportunity to work with your patients.

We recognize that medications for hypertension are valuable, but they can be employed along with a variety of other strategies. Patients need health coaches to lose weight and adopt healthier lifestyles. That is not something that is generally taught in medical school. Too many drugs for high blood pressure cause unpleasant side effects:

• Sexual dysfunction
• Hair loss
• Swollen ankles and fluid retention
• Fatigue
• Insomnia
• Loss of potassium & magnesium
• Lipid abnormalities
• Cold hands and feet
• Dizziness
• Elevated blood sugar

It takes a partnership between physicians and patients to find the right medicine that won't ruin the quality of a person's life.

I didn't start having this persistent cough until the doctor prescribe Benazepril on February 5th. I too am experiencing persistent cough day and night, and it's causing me to get a sore throat, and my chest hurt, and a runny nose. Unfortunately, because I'm a new patient. I wasn't able to schedule an appointment to see the doctor until Friday, March 30th, to see if the doctor can change my medication. This persistent coughing is really affecting my daily life.

to Eileen - you can't get into you doc till next month? Get used to it. Doctors have not been going into primary care for several years do to all the hassle with insurance, paperwork and the government. There has been some increase in applicants recently but it won't be enough once Obamacare kicks in and we suddenly have 20 million more patients to see. In a few years you will see a PA or NP (no necessarily a bad thing) and probably not the doc because he will only be seeing the sickest of the sickest.