angioedema, choking, man sticks out his tongue while coughing

Humans are programmed to quickly associate symptoms with exposure to some toxin. This was an incredibly adaptive learning process when our ancestors were hunters and gatherers. If a member of the tribe developed severe stomach cramps or diarrhea after eating a certain leaf or root, it would be useful for everyone to know to avoid that plant. But what happens when a side effect takes months or even years to develop? A delayed cough with lisinopril for high blood pressure can be challenging for patients and doctors.

How Come It Took Years for a Delayed Cough with Lisinopril?

Q. I’ve been taking lisinopril for many years. I know one of the side effects is a dry cough, but I never had that problem. Suddenly now I do.

Has this drug been re-formulated? My cough is intense, and my throat is very dry for the last several months. I plan to discuss this with my cardiologist.

A. Some people develop a troublesome cough within several weeks of starting on an ACE inhibitor blood pressure pill like lisinopril. Others, however, may not start coughing for months or even years (European Journal of Internal Medicine, Jan. 2017).  Sometimes this delay leads to misdiagnosis. Read much more about this common mistake in our book, Top Screwups at this link

Charles Also had a delayed cough with lisinopril:

“I developed a cough after being on Lisinopril for several years. The cough was constant and almost debilitating. I brought up that issue to my doctor after researching (really internet searching).

“She noted that in her practice the cough develops eventually for about 30% of users despite some claims of only 5-10% of occurrence. Wish she had spent some time discussing this risk with me from the time of the first prescription.

“The aggravation is that it took some time to lose the cough using another class of BP medicine that I had to go through 3 more types of medicines before I had the right one.”

Angioedema with Lisinopril:

Mark got lucky. He only had lip involvement after 30 years on lisinopril:

“I have been on lisinopril for 30 years and have lived with the cough and other annoying side effects until recently when my lower lip swelled up like a bratwurst!! No kidding! Has happened 4 times now and my new doctor just took me off lisinopril because of the swelling. Now it’s on to the next BP medication or perhaps not.

A much more serious angioedema reaction happened to David the Pharmacist. He had a different kind of delayed lisinopril reaction:

“I too had an angioedema-type reaction to lisinopril. Initially watery itching eyes, progressing to facial swelling then difficulty talking and finally breathing. I went to the ER and was immediately diagnosed with angioedema.

“First question was: ‘have you been taking lisinopril.’ Epinephrine will not reverse this reaction. Steroids and IVs are needed. Why no black box for this group of drugs I will never know. The delayed reaction after years of taking lisinopril makes one think that the drug could not be causing the problem. As a pharmacist I know what the package insert says, but after practicing for over 40 years, I still did not understand the severity of such a reaction. This is a dangerous drug, BLACK BOX IT!!!

“The biggest problem is that the angioedema can occur suddenly after taking the drug for years. Why is the FDA delaying this action? Supposedly when it was first introduced, it was thought that since the reaction was so rare that the warning was not needed despite this reaction being deadly.

“It was also rumored that if the warning were included it would preclude the drug being prescribed widely. Surprised? I personally had such a reaction at 10:00 PM one evening. Fortunately I live only 3 miles from emergency care. If I had been on an extended airline flight I would be dead.”

Reader Response?

Have you ever had a delayed reaction to a drug? What about a delayed cough with lisinopril. Share your story in the comment section below.

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  1. Melinda
    San Antonio
    Reply

    My mother’s dose of lisinopril was upped from 10mg to 20mg during a recent hospital stay. She developed urinary retention and had to come home with a Foley catheter. I read the side effects and buried deep was the comment that urinary retention was a side effect. We reduced her dosage and the catheter was removed and no urinary retention!

  2. Nelda
    North Carolina
    Reply

    I was on Lisinopril for many years and recently experienced two continuous coughing episodes with 24 hours, the second one lasting over 45 minutes nonstop. I felt like I was trying to cough something like an insect out of my lungs. The doctor I saw next morning at urgent care quickly attributed the cause to Lisinopril. The dry cough continued for brief episodes for several days after I stopped it, but no longer occurs.

  3. Jean
    CT
    Reply

    Lisionpril is a bad drug and needs to be taken off the market. Was on it for 2 months, lips swelled, and the dry cough was nasty. Took myself off and bought a blood pressure cuff to chart my BP, daily. I do not have a BP problem except in my doctor’s office.

  4. MJ
    NC
    Reply

    LISINOPRIL was the final drug I could stop taking. So glad my B/P dropped, along with my weight, when I went on the blood type diet. Now I take NO meds, just vitamins, mineral, etc. for support. After 70+ years I am enjoying life for the first time. My doc is all in with this sort of lifestyle change. So lucky I found her. She grins big when I tell her how great my body and spirit feel. Now food is my medicine. The sacrifice of ice cream and other dairy, etc, is a small price to pay. Wouldn’t touch ice cream on a bet anymore!

  5. Kate
    NC
    Reply

    I experienced the cough problem caused by Lisinopril within a year of so of its being prescribed. After doing some reading about the drug on my own, I contacted my primary care physician and asked to be switched off it. The cough dissipated and disappeared within a few months. Now I’ve had to ask my dr. to switch me off Losartan. He was dubious, since my pharmacy hadn’t notified me of a recall on my particular supply. I don’t have any confidence that I will be notified by anyone if my supply is contaminated; not the drug company, not the pharmacy, not my fairly clueless medical personnel, who had the nerve to be impatient when I asked to find another drug.
    We are our own best medical advocates these days.

  6. kyoom abdool
    TOTONTO,CANADA
    Reply

    I am a 71 year old male and I also had been on Ramipril (ACE inhibitor) for over10 years !
    I had an MI in May of 2016.In June of 2016 @ around 1030pm I started to develop Angioedema on the right side of my face and lips.
    Being a Respiratory Therapist ,for the last 45 years and having seen this in some of my ER patients before I asked my wife to take me to the ER.(This was not a smart move, we should have called the EMS)

    The ER was only 9 Km away.
    The triage nurse was quick to confirm my diagnosis and I was started on IV steroids and iv Benadryl .
    They we preparing to intubate me if things got worse.
    The swelling finally started to go down after 10hrs in ER and I was discharged.

    My opinion: This drug (ACE and ARB’S) should be black boxed!!!

    I would never take an ACE inhibitor again. There are better anti hypertensive and cardio protective drug on the market.

  7. BBBob
    Amherst, NY
    Reply

    When first prescribed Capozid/HCTZ in 1980, and later captopril/HCTZ, and finally Enalopril/HCTZ (all the same family of ACE inhibitors), my cough didn’t show up until at least 10 to 15 years after I began taking these prescriptions. It was me, not the doctor, who put 2 and 2 together to figure out what was causing the cough.

    My then “new” doctor switched my prescription to Avalide, which the HMO forced a change to Irbesartan/HCTZ (generic), which I didn’t like but was forced to accept. With the current rash of contaminated ARB products manufactured in China and distributed through India, I wish that U.S. healthcare organizations would see the folly of their profit-making choice to buy foreign-made drugs which actually risk the health of the people they are intended to help.

    I know something about manufacturing costs and profits and believe that U.S. drug makers could be persuaded to sell their better/safer products for more reasonable prices and make up any slight loss of obscene profit by means of larger manufacturing and sales volume. It might also help if the our “look-the-other-way” government tried to “jawbone” with U.S. drug makers to see the logic of this argument, and perhaps make “American-made” generics available by assisting the establishment of U.S. generic drug manufacturing plants for these popular and necessary drugs. Is it unreasonable to contact our elected officials to ask them to examine this important matter and try to help find a solution?

  8. Linda
    Helena
    Reply

    I was just switched to this medication — I will certainly be vigilant. Seems like forever will be the requirement.

  9. Steve
    Clinton, WA
    Reply

    Please do not use terms like “angioedema” without some explanation of what happens and how to counter it.

    Please do not use a term like “black box” without explaining it.

  10. Beth
    Reply

    I took lisinopril for a year before I started coughing.

  11. Linda D.
    Indiana
    Reply

    I have been taking lisinopril for 45 years and never have had any symptoms of a cough or swelling. It has gotten me to 80 years young.

  12. James
    Missouri
    Reply

    I’ve taken Lisinopril for 5 years, and the only side effect I have had has been an occasional dry cough which comes and goes and isn’t debilitating. Usually a small glass of water or a cough drop causes it to disappear rather quickly.

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