Lisinopril is a widely prescribed medication for managing high blood pressure and certain heart conditions. It belongs to a class of drugs called Angiotensin-Converting Enzyme (ACE) inhibitors. While effective for many, a notable side effect for some individuals is a persistent, dry cough. This cough can be bothersome and often requires medical attention.
Understanding the Lisinopril Cough
The cough associated with lisinopril is typically dry, non-productive, and often described as ticklish or irritating, sometimes worsening at night. It can develop anywhere from hours to weeks or even months after starting the medication. This side effect occurs because lisinopril inhibits the ACE enzyme, which is responsible for breaking down a substance called bradykinin in the body. When ACE is inhibited, bradykinin accumulates in the airways, leading to irritation and an increased sensitivity of cough reflexes. The incidence of this cough varies, affecting approximately 5% to 35% of patients using ACE inhibitors.
Why Self-Treatment Isn’t Recommended
Attempting to self-diagnose or self-treat a cough while on lisinopril is discouraged. A cough can stem from various causes, and it is crucial for a healthcare professional to confirm if lisinopril is indeed the culprit. Discontinuing blood pressure medication like lisinopril abruptly, without medical guidance, carries risks. This can lead to rebound hypertension, where blood pressure suddenly rises to dangerous levels, increasing the risk of serious cardiovascular events such as strokes or heart attacks. Therefore, any changes to medication should only be made under the direct supervision of a doctor who can assess the situation and recommend a safe course of action.
Medical Approaches to Eliminating the Cough
When a lisinopril-induced cough becomes problematic, the primary medical approach involves discontinuing the medication. The cough typically resolves within one to four weeks after stopping the ACE inhibitor. A healthcare provider will then usually switch the patient to a different class of medication that offers similar benefits for blood pressure or heart conditions without causing the cough.
The most common alternative is an Angiotensin Receptor Blocker (ARB), such as losartan or valsartan. ARBs work on a different pathway to control blood pressure and do not lead to the accumulation of bradykinin, thereby avoiding the cough side effect. Other suitable alternatives that do not typically induce a cough include calcium channel blockers like amlodipine, or thiazide diuretics such as hydrochlorothiazide. Close monitoring of blood pressure is important during and after the switch to ensure effective management of the underlying condition.