The People's Perspective on Medicine

Why Don’t Doctors Recognize Lisinopril Cough?

Why do so many doctors ignore the cause of a lisinopril cough? It would be as if a mechanic ignored the check engine light on your dashboard. It is NOT OK!

We have been writing about drug-induced coughing for more than 30 years. In the beginning we tried to be diplomatic. Here is one of the first questions we ever received on this topic (March 28, 1988). “Q. Can you recommend a cough remedy I can take for a persistent night-time cough? Most of the brands I have seen caution not to use them if you have high blood pressure. I take Capoten (captopril) to control my blood pressure, so I’m not sure if the warning applies to me. Our answer: A. You may not need a cough medicine as much as a consultation with your physician. One of the annoying side effects of captopril can be a dry, hacking cough. It would be a shame to guzzle cough syrup for years trying to control an adverse drug reaction. Your doctor can determine if your medicine is giving you trouble, and if it is, he may consider an alternative medication.” After decades we have lost our patience. A recent question about a lisinopril cough prompted a less tactful response from us.

The Lisinopril Cough from Hell:

Q. I had a severe cough from lisinopril. When it started, I went to my doctor and he sent me to an Ear Nose and Throat Doctor.

The ENT doctor said the cough was from acid reflux and gave me a prescription. No change in my cough.

I had to quit my job because when a coughing spell started up, I had to race to the bathroom and throw up. It interrupted me with customers or on the phone.

I started looking for an explanation online and found out that lisinopril could cause a cough. My doctor said I needed to stay off the internet and that my theory was nonsense.

I decided to go off lisinopril anyway. About a month later, I stopped coughing. My doctor didn’t like my self-diagnosis and put me on a different blood pressure medication. I started coughing again. I need to find a blood pressure med that will not make me cough.

The ACE Inhibitor Cough Is Common!

A. Your doctor might have prescribed another ACE inhibitor. Such medications are renowned for causing uncontrollable cough.

Here is a list of ACE inhibitors. They can all cause an uncontrollable cough. No amount of cough medicine will calm this cough.

ACE Inhibitors:

  • Benazepril (Lotensin)
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Fosinopril (Monopril)
  • Lisinopril (Prinivil, Zestril)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)

Doctors SHOULD Recognize a Lisinopril Cough!

No one gets through medical school without learning about ACE inhibitors and cough. It is probably the most common side effect of such drugs.

The precise incidence of an ACE inhibitor cough is not known. Reports have it showing up in anywhere from 5% to 35% of patients (Chest Jan. 2006).  It can come on within hours of taking the first pill or it can take months to reveal itself.

One researcher reports in the Turkish Throacic Journal (Jan. 1, 2019) that a lot of patients discontinue ACE inhibitors because of cough:

“Although they are well-tolerated medicines, almost one-fifth of patients discontinue their treatments due to side effects, especially cough.”

Will Stopping an ACEi Control the Cough?

If a lisinopril cough is correctly diagnosed and the doctor tells the patient to stop the ACE inhibitor, it can take weeks or months for the cough to gradually go away. This can be incredibly frustrating, since most people assume that once the drug is discontinued the cough should go away promptly.

Other Cases of Lisinopril Cough:

We have been writing about this for so long that we have lost patience with doctors who either do not recognize a lisinopril cough or just don’t care. Here are a few stories from readers:

Bill in Charlotte, NC, shares his frustration:

“I’ve had the same experience many others have had who commented on your website. I had borderline high blood pressure. My primary care physician put me on lisinopril. The cough began within days.

“I called and was given another ACE inhibitor. The cough still continued. After two months of coughing, I went back and explained what was happening. I was told to ‘deal with it’ for another few weeks as he didn’t think it was worth stopping the drug for. I am frustrated and angry.”

Patricia in Australia reveals that this is an international problem:

“I was prescribed lisinopril in the UK about 8 years ago. Around the same time I developed a dry cough that was sometimes so violent it caused nosebleeds and incontinence. I did not make a connection between the cough and lisinopril.

“I have just been advised by my GP in Australia to double the dose to 10 mg as I have some protein in my urine. I noticed on the new pack not to take potassium supplements with the medication. This led me to investigate further the side effects of lisinopril and so I landed on this website.

“It’s only now that I can make the connection between the cough and lisinopril. I wonder now where I go from here?”

If you want to read more stories of lisinopril cough, here are a few links to consider:

When Will Doctors Pay Attention to an ACE Cough?

Lisinopril Cough Drove Reader to the End of the Rope

Where Patricia and the thousands of other victims need to go is back to their doctors. The ACE inhibitor cough can only be corrected by changing blood pressure medicine to a completely different class.

Our book, Top Screwups, documents this frequent prescribing problem in detail. It is available at www.PeoplesPharmacy.com. It will provide you with details about interacting politely with your doctor to get the most appropriate treatment.

A different type of medication such as an ARB (angiotensin receptor blocker) might be more tolerable. Due to manufacturing problems, there are shortages of drugs like losartan and valsartan. Your doctor may need to find a completely different approach to control your hypertension.

Share your own ACE inhibitor story below in the comment section.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Yes, I understand what people went through. I went through this for a few years, not knowing what was causing this cough. It was not only a cough but after some time, on occasions, I couldn’t catch my breath. Not being able to catch my breath, I ended up in the emergency room at least six times. Each time I ended up in the emergency room I explained my medications and medical history to the doctors but they just couldn’t put two and two together.

Finally, I stopped taking the lisinopril and had my doctor switch my blood pressure medication. Then I had her schedule me for a CAT scan due to my cough. My CAT scan showed a nodule. I was then referred to a pulmonary doctor. He reviewed my x-rays and found inflammation on my lungs. After extensive bloodwork and tests for bronchitis and asthma, he put me on steroids and an antibiotic. So far, it’s cleared things up so that I am able to breathe normally and stop coughing.

I take 5 MG of Lisinopril and no cough. Is 5 MG a low dosage that won’t cause a cough?

People vary in their susceptibility to the cough. Some react even at a low dose, while other are less likely to do so.

I had a bad cough from Lisinopril. My pharmacist recommended that I take Losartan Potassium so I told my Doctor & she gave it to me. No more coughing.

I was told this is actually an allergy and could be life threatening if ignored.

It’s a response to bradykinin rather than an allergy, but it shouldn’t be ignored.

I also developed a cough when I was first put on a low dose of Lisinopril, but it went away after several months (3-6). However, the urge to clear my throat has lingered, even though it has diminished. It is now mild and tolerable. I haven’t wanted to go to the bother of switching medication type because of all the ARB recalls and shortages and side effects common to those medications.

What really freaks me out about Lisinopril, however, is the possibility that even after years of uneventful use, one can suddenly have an anaphylactic reaction to it. Yikes!

Ten to twelve years ago my doctor prescribed Lisinopril for blood pressure. In a short time I got into a severe cough and sore throat that I would describe as similar to strep throat and whooping cough (I had these as a child). I asked the doctor if the medication could be causing a problem. He blew me off and said I had a cold. I stopped the medication on my own, and within two days the cough subsided. After a couple of days I started the Lisinopril again, and within a couple of days the cough and sore throat were back.

I fired the doctor and got another who agreed with me that the medication was likely the problem. She put me on a different blood pressure medication, and I had no reccurrence of the problem.

I didn’t have a problem with lisinopril, but did with flecainide. This is not listed as one of the side effects, and it didn’t start right away. I had violent, uncontrollable coughing caused by a tickle that did not stop until I almost threw up. When I would reach this point the cough would subside. The doctor would not listen to me, but agreed that my blood pressure was low enough to take me off. The coughing stopped.

My question is: Why do doctors refuse to recognize any medicine side effects???
Very, very frustrated with our medical system and doctors.

I have been on Lisinopril for years, and the cough has gotten worse. It is now a deep cough. My fear is that it could develop into something worse because I get bronchitis a lot. I also take Metoprolol. I have also heard that African-Americans should not take Lisinopril. Is that true?
What can I do?

I coughed for 1.5 years on lisinopril before a doctor made the connection. It didn’t help that I had just moved to Florida and discovered I am allergic to oak trees. And then red tide hit the West Coast of Florida and I literally could not be outdoors for a year! I had been in the midst of planning bladder lift surgery for incontinence, but had to shelf those plans since constant coughing aggravated it. Now I can finally focus on it again. Any time I hear someone complaining about a constant cough, I ask if they’re on high blood pressure meds. Pass it on!

Reading the letters from people with this problem, I again see the astounding arrogance of the medical profession. In medical school, their education is focused on symptoms and the drugs that are supposed to reduce them. You see the schools are heavily funded by drug companies. In her book, “Medicine and Cultures”, research journalist Lynn Payer interviewed a number of US medical students who told her they were reprimanded in class if they asked too many questions about side effects. Dr. Howard Brody, in his book “Hooked” suggests that the exclusive rights of drug patents and physician exclusive rights for prescriptions made doctors the main sales force for the drug industry. Under all this is the simple idea that doctors do not look for the primary cause of a person’s high blood pressure. After all, there is no profit to be made with effective prevention. This is heart breaking to me after 45 years of health care practice. As a result I have fired a number of doctors for their ignorance. RN, MS, LCPC, Integrative health Advocate.

Doctors are just drug pushers and aren’t trained in what they should do, just which drugs to write for.

My 91 year old Mom died in 2017 from pulmonary issues CAUSED by years of lisinopril and amiodarone. The admitting Dr in her last hospital visit told me that these two medications caused hardening and scarring of the lungs. Mom had cardiologist, pulmonologist, and other doctors. She constantly asked about her coughing, weakness (from not getting adequate air), etc. and thought her medications were responsible. Doctors, everywhere, all of them, are useless. Don’t Get Sick!

When will doctors begin recognizing an ACE inhibitor cough?

Answer: When the pharmaceutical companies stop rewarding them for every prescription they write for them!!

Last year, I finally got as concerned as my doctor about my elevating blood pressure. She first put me on lisinopril, but the cough started right away, so we tried losartan, with the same result. I have now been on metoprolol at a low dose, a beta blocker, and have no noticeable side effects. I’m lucky that my doctor listens to me and isn’t trying to get my BP to ridiculously low levels for my age. But I do wonder sometimes if this drug is good for the long term. I’m 70 years old and on no other meds. What do you think about beta blockers?

I had been taking Lisinopril for about a year with no problem when my doctor raised to dosage to better control my blood pressure. I started coughing with a few weeks but did not associate the higher dose with my cough. My doctor said may e it was Whooping Cough and proscribed an inhaler, which didn’t help. At the time I worked as a phone rep, and it was interfering with my job – plus the cough was just making me miserable. After doing some research, I found out about the “Lisinopril Cough”. I demanded a different BP medication (and no, my doctor did NOT want to believe me but I told him I wouldn’t take it any more so he had to do something). Within two weeks, cough was gone.

I am a physician and I am well aware of this side effect, as are many of my colleagues. Not all physicians fail to notice the correlation.

I was getting so upset with this cough – waking me up in the middle of the night, inappropriate times during the day, and painful until ….. a friend (whose brother is a doctor) was over and I mentioned how frantic I was getting over this cough and she asked me if I was taking lisinopril! Her aunt had the same problem and as soon as she stopped taking the medication the cough stopped. So I stopped and it was gone – so simple. My doctor never even mentioned this as a possibility when I went to him with my concern?

I also developed a cough after taking benazepril for years. My cardiologist sent me to a pulmonary specialist. After numerous tests, nothing was found. I was given a cough suppressant.

My pharmacist told me about the cough associated with benazepril. I went back to my cardiologist and he gave me a prescription for lisinopril. My cough continued. When I talked to the original pharmacist, she said the new prescription was a member of the “pril” family, and I should go back to the cardiologist, and get a different medication.

My cardiologist was not happy that a pharmacist was “diagnosing” my problem, but did give me a different medication. After almost 3 weeks, the cough started to subside. After 2 months the cough was gone. The numerous trips to different doctors, plus the persistent cough could have been prevented.

A man I worked with had this terrible dry hacking cough for almost two years. He would cough so hard that I wondered if he had lung cancer. One day, he coughed so hard that he had a stroke. He did recover but we found out that it was the Lisinopril he was taking that caused his violent coughing.

I was livid when I realized my constant throat-clearing was due to Lisinopril, after a year or two. I now take Losartan and still have some of the irritation, but not nearly as much as I did with the Lisinopril. Why are doctors so reluctant to admit a side-effect exists, though the manufacturer may not call it “common”?

A few years ago the doctor put me on Lisinopril. It wasn’t long before I started coughing ~ sometimes running to the sink in case I threw up ~ awful. A few weeks after I started, I had blood work done. My glucose was up to 106. The doctor wasn’t concerned, but I told her I could fix that. I went home, stopped the Lisinopril, and then was able to quit having a hard butterscotch candy in my mouth 24/7 to quell the cough. A few months later, my cough was gone, and my glucose was 89.

Now I take L-Arginine and my blood pressure is great. I have a friend who broke some of his ribs from coughing. I asked him if he was on any medications ~ he was on Lisinopril!

ARBs work similarly to ACE inhibitors like Lisinopril and are a good substitute. The problem is that a lot of them have been recalled due to manufacturing problems in China. I am puzzled about why doctors don’t start patients on diuretics like HCTZ which are very effective and have few side effects.

HCTZ is known to cause gout. Seems like every medication has something but not everyone has a reaction because each person is different. What works for me may not work for you and vice versa.

Within 2 weeks of being prescribed Lisinopril I developed a really annoying cough. As soon as I described the cough to my cardiologist, he immediately said he was changing the medication and that I was not to take any ACE med ending in “pril” because I have a sensitivity to it and would develope that cough. Within 2 weeks of stopping Lisinopril, the coughing stopped.

My cardiologist started me on Lisinopril in 1999. After a while, probably 2 – 3 months, my wife noticed this dry hacking cough that I had not noticed since it was not loud, just irritating. I called my cardiologist, he had me come in, went over everything and he discontinued the Lisinopril and started another medication. He said it was a side effect of Ace Inhibitors. The new medication did not cause any problems. That was 20 years ago! I glad he listened to me. Also glad I listened to my wife!

I had the lisinipril cough. I had other issues with blood pressure meds.
I take htcz. So far so good.
I insisted that my doctor find a different drug. She sent me to a heart specialist. That worked.
Please people, demand, insist or find another doctor. It’s your life, control it.

I was on lisinopril. I had a dry annoying cough. I read the possible side effects which includes a cough. I asked my internest about it, and she did nothing. Finally I asked to be put on another medicine. She put me on Losartan. The cough went away. I guess one has to be proactive. Even though I have confidence in my internist they can’t do it alone. It’s a partnership.

I was given Lisinopril by my doctor. I developed a terrible chronic cough. I happened to mention it to my pharmacist, and he told me that it was the Lisinopril. I quit taking it, and the cough went away.

My mother-in-law was a tiny woman with a big cough that I believe was from Lisinopril. When she fell and was bed-ridden at 89, for hip surgery, she was put in a nursing home for what was the last year of her life. Her loving family caretaker was one to follow “what the doctors said.” I lived on the east coast, and she was in the southwest. I felt I had to tell her caretaker that I had had the same cough from this BP medicine, and as soon as I asked to replace it, with an ARB, which needed a note from the doctor to get approval, nevertheless, my cough stopped! We can, as patients or caretakers, step up and say please write it in my records that I did not comply with the Lisinopril, so you will not be responsible if I have another heart event. He was kind of impressed with my polite forth rightness and got me an ARB. That was eleven years ago. My poor dear mother-in-law, however, coughed and coughed until her chest muscles and ribs constantly hurt, as she tried her best to recover from the hip surgery. But she did not recover. I miss her still. She had courage and died trying.

I have been on Lisinopril for about 20 years. I haven’t experienced the often-reported cough, but maybe a different symptom.

Over the past year I have found a tiredness that was striking. I could be sitting down at my desk working and would suddenly feel that I needed to close my eyes and rest for a few minutes. Next thing I new I was in a deep sleep. At different times during the day I would fell very sleepy. And then, an event occurred that connected my tiredness to Lisinopril.

My doctor denied a request from my pharmacy to refill my prescription. I had several days remaining on my prescription. I eventually ran out of pills before I found out he wouldn’t write a script until I scheduled an office visit.

As an aside, I may be changing physicians for a very specific reason. I have 5 years of BP records indicating BP in the 128/80 range. When visiting his office it is alway elevated. He told me I needed to continue with meds. I asked about my cholesterol numbers. He dismissed my information.

So now I am going into day number 4 without Lisinopril. Remarkably, I feel more energetic and not like I need to rest or nap. I also take steps using nutraceuticals to control BP like celery juice, Q10, berries, nuts and other things. I think I’m going to forego BP meds and monitor.

I spent many years of my career under healthcare and know that it is impossible for doctors to be all knowing. Just too many things to know. What does substantially bother me is the lack of desire to listen to patients.

Several years ago my doctor prescribed Lisinopril for me. After taking it for about a month I developed a really persistent dry cough. Since I was out of town and couldn’t see my doctor I decided to look on-line. The only pill I took was Lisinopril, so I googled “Lisinopril Cough” and, lo and behold, there were pages of reports about coughs caused my Lisinopril.

As soon as I got home, I saw my doctor and told him, he literally laughed in my face and said that there was absolutely no correlation between my cough and Lisinopril. I asked to be put on another blood pressure medication, which he did reluctantly, and within days my cough was completely gone. Not only did I change my medicines, I immediately changed my doctor, too!

My 80 yr old mother has Parkinson’s disease and was also was suffering from a debilitating cough that was often causing her to feel oxygen-deprived. Her GP was considering referring her for an upper GI evaluation when, after doing my own research, I asked if it could be due to the lisinopril she had been taking for a while. A week after she ceased taking the medicine, the cough was gone.

I had been on Lisinopril for about 6 months. Went to PCP for a cough and was told it was left from Streptococcus and prescribed more cough medicine. Went to the Urgent care twice. The second time I saw a Nurse Practioner. She said I needed to let my PCP that I had an ACE cough. This time she listened to me. It was part of the warning speech she gave me when I started it.

I was put on a low dose of lisinopril and developed a cough in the first month. At first I thought I had a cold but when it persisted I realized that is was a side effect and asked my doctor to change my medication. The bad thing was that the cough/tickle bothered me for a few more months. It was very irritating, and I am so glad it has stopped now.

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