Lisinopril is a medication widely used to manage high blood pressure and certain heart conditions, including heart failure and after a heart attack. It belongs to a class of drugs known as angiotensin-converting enzyme (ACE) inhibitors. While generally effective, a persistent, dry cough is a recognized side effect associated with lisinopril and other medications in this class. This cough can be bothersome for individuals taking the medication.
Why the Cough Occurs
ACE inhibitors block the activity of the angiotensin-converting enzyme, which plays a role in regulating blood pressure. This enzyme also normally breaks down a substance called bradykinin. When ACE is inhibited, bradykinin accumulates in the respiratory tract.
This buildup of bradykinin is thought to irritate nerve endings in the airways. This irritation triggers a dry, non-productive cough, meaning it does not produce phlegm or mucus. The cough can be described as a tickling or scratchy sensation in the throat. While the exact reasons for this irritation are still being investigated, the link to bradykinin accumulation is well-established.
How Long the Cough Persists
The duration for a lisinopril-induced cough to subside after discontinuing the medication varies among individuals. For many, the cough may begin within weeks or even months of starting lisinopril. Once the medication is stopped, the cough typically resolves within one to four weeks.
However, in some cases, the cough might linger for a longer period, potentially up to three months. This extended duration occurs as the body needs time to clear the accumulated bradykinin and for the irritated airways to heal.
Strategies for Addressing the Cough
Individuals experiencing a persistent cough while taking lisinopril should consult their healthcare provider. It is important not to stop the medication abruptly without medical guidance. The medical team can assess the cough and determine the most appropriate course of action.
A common approach involves switching to an alternative class of medication, such as an Angiotensin Receptor Blocker (ARB). ARBs work differently than ACE inhibitors, affecting the same blood pressure pathway but without interfering with bradykinin breakdown, thus significantly reducing the risk of cough. Over-the-counter cough suppressants are generally not effective for this type of cough because the underlying mechanism is different from a common cold.