The People's Perspective on Medicine

Doctors Missed Cause of Cough

Q. Your column saved my life (or at least made it worth living again). I have been in lisinopril hell for over three months.

My insurance company switched me from Micardis, a blood pressure medicine that had no side effects, to lisinopril. They gave me six months free. If I had not agreed to switch, I would have had to pay $100 a month for the Micardis.

Almost immediately, I became incapacitated with a violent cough. It made me choke, gag and vomit, and even lose my bladder control.

At first I thought I had caught the flu. A doctor then diagnosed a sinus infection. Antibiotics didn’t help. I went back to my doctor, who dismissed my symptoms by sending me to an allergist.

The allergist had me fill out a lengthy history in which I mentioned the lisinopril, but he did not make the connection either. Instead he put me through a series of very expensive breathing tests and gave me breathing medicines (also expensive). Needless to say, none of this worked.

I was becoming depressed because the cough was interfering with my sleep, work and social life. Then my neighbor showed me your column about lisinopril cough. I stopped the drug and have completely recovered.

A. We are so pleased you are better, but we never want anyone to stop blood pressure medicine on her own. You’re right that your doctors should have realized that cough is a side effect of ACE inhibitors like benazepril, enalapril, lisinopril and ramipril. Many other blood pressure medications do not have cough as a side effect.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I have lung fibrosis. I had a blood pressure attack and was given lisinopril. My blood pressure was ‘fixed’ …but after 6 months I began to cough. I had heard about ‘lisinopril cough’ and asked my Dr. to change me to something else. He said ‘it couldn’t be the medicine…and was probably my lungs.’ I limped along coughing all night and planning to get my affairs in order.
I went back to the Dr. and insisted on another drug. He prescribed catapres; however, he didn’t seem to ‘know’ what he was doing… I filled the prescription and began taking it…. it’s been THREE DAYS and I feel like I have a new lease on life. My chest expands and the cough is almost gone!! (I guess it can take a couple of weeks).
Here’s what I know: Lisinopril does lower blood pressure… but there are other drugs out there. Don’t be ‘fooled’ into thinking it’s ‘not’ lisinopril if you develop a wracking, painful cough-even though you’ve been taking lisinopril for a few months (one lady developed it after two years).

I was taking Avapro for years and doctor changed me to Lisinporil due to the cost being much cheaper.
I have been taking Lisinporil now for several years and have a cough, but not severe at all. I cough infrequently throughout the day.
slight coughing. No chocking, vomiting or other things your writers have written.
Do you think I should change back to Avapro? It is much more money..
but if I would benefit, I would change. I take my medication Lisinporil and Simvastin at night .
Appreciate it if you would send me your opinion.
Shirley K.

Most Drs. seem to be adamant about denying the side effects of drugs while thousands of patients document them. We decided a severe bout with vomiting, diarrhea and weakness after taking 10 mg of Zestril was just coincidence but the Dr. stopped it anyway. Difficulty with an ARB prompted a retry with 20 mg of generic Vasotec, another ACE.
Vomiting, diarrhea, weakness so severe that a trip to the emergency room and hospitalization for 3 days was the result. The ER Dr. insisted that it could not be the drug. $75,000 of every scope, CT, blood tests etc that they could think of resulted in mild acites and slightly enlarged liver diagnosis with bladder infection.
Three weeks later a followup CT with contrast indicated normal liver and no acites. In the end they figured out nothing so we feel it had to be an unusual reaction to the drug.

My husband was put on Lisinopril, Metoprolol Succinate, and aspirin daily even though he has never had high blood pressure. He has a mild and infrequent cough which he does not consider a problem. He has developed swelling in the right foot and what appears to be a raised blood vessel on top of the foot. Soaking in Epsom salts and keeping the foot elevated helps, but when resuming normal activities, or simply sitting and reading without his foot elevated, the swelling, redness, and discomfort returns. I think it is a side-effect of the Lisinopril, but find no comments on your site that this can be a side effect.
Thank you for your reply.

I started taking Lisinopril a month ago. the cough started right away, but I thought it was a bad cold. I continued with the meds for two weeks until my next doctors appointment. He took me off of them and put me on Benicar, which works great for my high blood pressure, but the cough remains. I read all of the comments about how long it takes to stop the cough and I wonder how in the world I will survive. This cough is horrible. I stay up all night, cough at work all day, and I am a bear to live with. Is there not anything that can make this cough stop sooner?

Karen said all that needs to be said about lisinopril & all “pril” rx’s. My husband developed a persistent cough after his heart valve replacement & being placed on this rx… I saw the People’s Pharm question & immediately called his cardiologist… they changed his med immediately & his cough dissipated after a few days. I have a friend that was just prescribed this drug & wanted her to know everything about it since she already had a cough (from sinus, etc) so I am forwarding her all the PP info on the “pril” meds.

I watch Dr. Oz every day, and he recommended that people take their cholesterol and high blood pressure medications at night because your blood pressure goes up at night and in the early morning and that is when most heart attacks occur, so I did that. I was taking 5mg. Lisinipril. But when I went to my gynecologist one late afternoon in November my blood pressure was up to 158/90.
I was very upset, and assumed that since I was taking my blood pressure medications at night it wasn’t keeping my blood pressure low enough for 24 hours, or my blood pressure was slowly trending upward. I called my internist and asked if I could double the dose, and the nurse said I should come in the next day to have my bp checked, which I did. It was again in the same high range. The nurse waited about 3 minutes and took my bp again and it was in the 142/85 range, so she tried to get me to leave. I said I wanted to see the doctor.
She spoke to the doctor and he said that if I want to see him I will have to wait almost 2 hours for a later appointment. I said I would. I told the doctor, not my doctor, that I was concerned about my higher bp numbers, and that Dr. Oz says optimal bp is 115/79, and I didn’t see what it would hurt for me to try to either double my dose or try another medication. He said that their is no evidence that keeping one’s bp that low does any good. I asked, “What would it hurt to try?” He allowed me to take a double dose, and instructed me that if I start to feel faint or dizzy I would know that my bp has gone too low, and to discontinue the double dose.
What I did was, I started cutting my pills in half, and took 1/2 in the morning and the second half last thing at night, and I have had no ill effects, and since I don’t want to obsess about my bp, I have not taken my bp since then, which was the week before Christmas, but I feel certain that my bp is lower.
The reason I decided to take my bp meds in two doses was because of all of the horror stories I have heard about side effects of lisinopril so I am trying to avoid those, and keep my levels even for 24 hours.

Rogers, I would contact the office manager and tell her to get your medical records ready because you feel that your Dr. is no longer competent to provide medical care. She will try to B.S. you and say that you have to pay for the records. Be persistent. If necessary, get a lawyer to write a letter compelling the Dr. to surrender the records.

I have been on Altace / Ramipril for six years. The cough has come and went over this period. Staying as long as 18 months at a time. Over that time I have tried many things. I am now thinking of changing medication or stopping BP medication all together. Doctors have been of no help. My primary doctor ignores me, the lung specialist seems to say stop the medication or keep coughing. The throat specialist was no help. Where does one go from here? I am now finding that drinking as much water as possible reduces the severity of the coughing spells. Hopefully it will help someone!

I developed the Lisinopril cough after taking it for years. I put up with it until I couldn’t take it anymore–as I had read it was a side effect. The drug works great for BP and no other side effects for me. It took a month for the cough to completely go away–now if I cough–it is something in my throat–as you would normally cough–not the gut wrenching –bottom of the stomach spasm, eye tearing, red in the face cough–starting with that dreaded little tickle!!!
So hang in there all of you–there is hope–after Lisinopril!!

You’re a nurse who cuts to the chase! — gave great info. on the “-pril” drugs. Now I have to deal w/my friend’s physician who just started him on lisinopril despite a hx. of intermittent asthma and chronic coughing b4 he started on the med! I thought he just had left over URI sxs. from last weekend.
Plus, his HR is running ~100 w/o exertion.
This is not good.

I took lisinopril and complained to my doctor for months with no results. She pretty much shrugged it off. I, too, was coughing, gagging, waking up at night choking and sometimes vomiting. Finally, when I was seeing a doctor about another matter, he casually commented, when I kept trying to clear my throat, that “that’s caused by the lisinopril, you know” I almost kissed him! I was sooooo happy to have that problem solved! Why don’t doctors recognize this side affect?

I took Lisinopril for six days and stopped. During the six days,my cough was horrid and my lunches and dinners spouted forth; the cough continued for two weeks after. M.D. said that she would note that in my file as an allergy. I changed physicians. Going through testing this coming week…

Dear Doctor,
Let me know whether Blood-pressure increases due to cough.
Regards,
Antony

I look forward to the day when medical technology advances to genetic testing for ability to tolerate and at least not have to go to the ER or worse yet expire on meds that don’t bother some people at all. Till that happens, we patients will be subjected to the guinea-pig approach.

I was on Lisinopril and I noticed that my gums were swollen. I brought this to the attention to the Dr and I was told that it was gingivitis. I had a dentist appointed scheduled and brought the swollen gums to his attention. It wasn’t gingivitis. I was suffering from Angioedema from the Lisinopril. My dentist called an ambulance and I was rushed to the nearest hospital where I was hospitalized for a week and a half.
Now I am on Cozaar and my blood pressure is still high and now I find out that I can suffer from Cataracts from this medication.
I am done. I will be seeking alternative medications instead of these patented medicines.

I’ve been taking Atenolol for five years, preceded by Lisinopril for at least five years. I’ve had varying degrees of coughing for most of those years, with my Dr. prescribing Nasonex and Loratidan for my non-productive cough? Sounds like my cough may derive from my Atenolol?
I’ll push my Dr. to rethink my symptoms and treatment. I’ve been loosing weight and am on half the earlier Atenolol dosage. The cough remains. It appears, with continued weight loss, I may be able to totally eliminate the BP medication next month. That should determine if there is a connection!

Physician gave me a new script for Lisinopril and her only remark was “…for kidney filtering..”(news to me; I have no kidney problems); the only side effect she knew of was “…of one woman’s facial swelling after taking it for 5 yrs!” I have not been diagnosed with high blood pressure.
I took it last week for 6 days and have coughed my head off in addition to gagging, throwing-up two lunches and one dinner… I shall call my Doc on Mon. a.m …I’m not taking this anymore after the last one on the 6th day.
Do you know of this med being prescribed for filtering problem w/ kidneys?

I was interested to read the side effects of lisinopril. I did not have any coughing that I remember. My Dr. took me off of atenolol and put me on the lisinopril. It gave me night sweats. I had to choose between sleeping or taking the lisinopril. Sleep won. I am back on the atenolol and off lisinopril now. I took it less than a month.

I went off my Lisinopril and cholesterol meds for two months. The cough stopped after 2 months. My blood stayed good until the two months. It was 125/79 all the time it fluctuated a few points up until the 10th week it then went up 154/97 I started back up and there I am coughing to the point of vomiting. The drug companies need to take care of this. It is debilitating. I can’t even carry on a descent conversation.

Any BP medication that ends in “pril” is an ACE inhibitor. Chronic cough is a well known side effect of these, but not all people will get a cough.
Changing from one ACE inhib. to another does NOT solve the coughing problem. It can take up to a month for an ACE cough to subside completely.
Any patient who is taking an ACE and starts with the cough should change medications to another family of meds, if the cough becomes intolerable. And any physician who tells his patients that it’s not the ACE (if no other cause is found) has a severe knowledge deficit. You should change doctors. These medications have been around a very long time and if your doctor is not aware of the side effects after all this time, he should quit medicine, or you should quit him.
There is no current remedy for the cough except to stop the medication.

I read with interest your article on Lisinopril. I have had the same systems as the article states. I did not know about all the systems that Lisinporil could cause. I do know that I will be contacting my doctor to see if I can go on another prescription to replace Lisinporil. Thanks for the informative article.

I had to switch from Lisinolpril for the exact same reason.

I went through the same thing with Lisinopril for about 6 months. My doctor had prescribed codeine cough medicine but I figured that I was liking it too much and it wasn’t really helping anyway. My cardiologist switched me to metoprolol and everything cleared up within two weeks.

I took Lisinopril for over a year. Went to two doctors, they treated me for everything for my cough. I was coughing all the time, night and day. Finally told my heart doctor, he changed me to Benicar. In 3 days time my cough stopped. Changed my life. My husband takes Lisinopril and hardly coughs at all.

I have been prescribed, over the past months Altace, Atenolol, Ramipril and Fosinopril for blood pressure, all of which made me cough frequently and to the extent that when driving a car I had to stop. Only Benicar worked properly. However my Medicare “D” provider said I couldn’t have Benicar and referred me to Avapro and Micardis both of which are more expensive both to me and the provider (according to receipts) than Benicar. Micardis still makes me cough a minor amount that I can deal with.

My husband took lisinopril for a few years and developed a pesky chronic cough from the start. He even saw the prescribing doctor separately about the cough a year or so later and was told not to worry about it, though it was not mentioned as a side effect of lisinopril. It wasn’t until my husband wrenched his back and was seen by a different physician at our local after hours clinic that the doctor noticed the cough and inquired whether or not he took a high blood pressure medication.
When told it was lisinopril, my husband was advised to call our regular doctor to change to a different medication. He did and was prescribed Avapro, which didn’t work as well. Now he’s on Exforge, which works well enough so far. However, this has been a process of several years and the cough is still there (though improved), which is worrisome. Very frustrating.

Isn’t Micardis an angiotension receptor blocker that has this month been revealed to increase cancer? Also Cozaar is included in the list of ARBs that increase cancer.
PEOPLE’S PHARMACY RESPONSE: YES, BOTH MICARDIS AND COZAAR ARE INCLUDED IN THAT ANALYSIS. THE ADDITIONAL RISK OF CANCER IS SMALL IN ABSOLUTE TERMS, BUT STILL MIGHT SUGGEST THAT ONE MIGHT NOT WANT TO RELY ON AN ARB FOR YEARS AND YEARS.

I also take lisinopril for blood pressure, and the detailed description of side effects–which accompanies my Kaiser prescription–definitely includes the possible arrival of a cough. My cough is not too severe, and I will wait for further developments before reporting to my doctor. But I do not understand all doctors not being aware of this particular side effect. I also wonder if the patient read the description that comes with a prescription. Her trials seemed so un-necessary!

I developed a terrible ACE cough after a few months on ramipril. When I visited my primary care doctor and cardiologist, they both immediately diagnosed the cause. The cardiologist switched me to losartan, and within two weeks the cough was gone.

I think lisinopril to be one of the most dangerous drugs on the market. It put me in the ER from violent coughing; I passed out twice; had frequent and uncontrollable coughing spells. I was 75 at the time. FINALLY the VA woke up and put me on metoprolol. But the after effects of lisinopril continue–before I took it, I could walk miles without problems; climb ladders, crawl under building; use a complete range of tools. Now I get winded walking 150′ to the mailbox and back, get short of breath just washing dishes. Lisinopril has pretty well ruined my life. And yet they continue to prescribe it!

My doctor switched me with no real reason. I had been taking atenolol successfully for years. Within days I started coughing and received allergy med prescriptions from my doctor. I couldn’t sleep because I coughed all night. I was miserable. I finally demanded an X-ray which was okay but then read on line about others who had similar symptoms to mine.
I stopped the lisinopril and it took me a full month to stop coughing. I have not coughed like that since. It seems to me that this should be a no-brainer for docs to immediately look to lisinopril when the patient has an out of control cough after starting on this med.

If you were doing great on Micardis and developed cough on Lisinopril you may want to ask your doctor if Cozaar may be right for you. It belongs to the same drug class as Micardis and it is available generically so there generally fewer problems with insurance coverage.
Marianna
http://www.healthialist.com

The first time I took Lisinopril I really liked it — inexpensive, effective little pill. Over a period of weeks I developed a rash and it became progressively more vicious. Daily it began before noon and created wild itching in legs and arms, worst in the groin area. Eventually I was developing slightly raised red spots on my hands, arms, feet, legs, thighs. Incredible itch (I wonder what was going on inside!) My doctor and I decided to discontinue it; the rash went away.
But I was uncertain if it was Lisinopril; I had been taking an iHerb supplement and thought it was more likely the culprit; I d/c’d that, too.
Recently, trying to get away from Atenolol (asthma) I tried Lisinopril again and within days the rash commenced. So now we’re convinced. Too bad, b/c it works great for some.
Also, I have a client who developed hyponatremia on Lisinopril that increased his susceptibility to seizures, which stopped when he switched from Lisinopril.

It is a mistake to assume that Micardis and other ACE receptor blockers have no side effects. First, I personally developed severe leg muscle pains and weakness on the drugs. Second, a new study reported in Lancet Oncology found an 11% increase in malignancies in people on these drugs. Yes, lisinopril and other ACE inhibitors are also associated with muscle problems, as well as the severe coughs; I will never take either of them again myself.

Try hydration — I found that when I increased my daily consumption of water, lisinopril ‘cough’ decreased.– add several more glasses of water throughout the day, if possible.

I too was taking Lisinopril and would like to know how long after stopping this medication should the cough subside? My PCP changed my HB medication almost a month ago and I am still coughing. Please let me know…. does it vary from person to person??
PEOPLE’S PHARMACY RESPONSE: IT VARIES, BUT SOME OTHERS HAVE REPORTED COUGHING CONTINUES FOR SEVERAL WEEKS AFTER DISCONTINUING MEDICATION.

I take lisinopril , but have not had any side effects of which I am aware. In fact , I actually feel a little better because the diuretic I was on was causing my potassium levels to be too low, however, I am taking the smallest dose at 5mg./day. Perhaps your dose is too high?

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