Chronic Cough Ace Inhibitor Side Effects
Chronic Cough - Ace Inhibitor Side Effects
About six months ago I started having coughing spells that seem to keep getting worse no matter what the doctor prescribes to control them. He's tried various antihistamines, antibiotics to treat bronchitis, and lots of different cough medicines. Right now I'm taking (500 mg twice a day), (10cc every four hours), and (every 12 hours). But the coughing spells last so long and are so violent that sometimes I almost pass out from them. I never cough anything up. Can you help me find out what is going on? This is totally ruining my life. Getty Images Can't stop coughing? ACE inhibitors may be to blame. A: Judging from what you've described, I'm almost certain that you have what I call an "ACE cough." The lisinopril you're taking is in a group of drugs called ACE (angiotensin-converting enzyme) inhibitors, which are typically prescribed to lower blood pressure and thus can lower the risk of , a type of progressive kidney disease that can occur in people with diabetes and eventually result in end-stage renal failure. In my experience, prescribers often place their diabetic patients on lisinopril just as a precaution. While that approach may have some merit with younger patients, the reduced renal function of older patients tends to negate all the possible benefits of ACE-inhibitor therapy.
One of the telltale adverse effects of ACE inhibitors, including lisinopril, is a chronic, hacking cough — a potential side effect that patients often don't hear about. Studies suggest that up to a third of all patients taking an ACE inhibitor will develop this type of chronic dry cough, and the cough often doesn't go away when they stop taking the drug. This happens more with women than with men, and more with African Americans and Asians than others. You might be wondering how a blood pressure drug could cause respiratory problems. ACE inhibitors affect the process of renal perfusion, which is how the kidneys filter impurities out of the blood. As an older person loses kidney function, the change is reflected in his or her glomerular filtration rate (GFR). The lower your GFR, the more difficult it is for your body to clear drugs from your kidneys and bloodstream, lowering their effectiveness and potentially causing them to accumulate at toxic levels in the body. In this case, the insoluble by-products of the drugs, called kinins, are not filtered out of the blood. They then flow out of the kidneys and lodge themselves in the lungs' bronchial tubes. The coughing spells represent the body's attempt to expel the kinins from the lungs. Even after the drug is stopped, the cough can linger for months until all the kinins eventually find their way out of the lungs.
Do You Have a Cough That Won' t Go Away
One of the drugs you' re taking could be causing it
l Q: I'm 67 and in pretty good health. Two years ago, when I was diagnosed with type 2 diabetes, the doctor put me on (500 mg each morning) to control my blood sugar and (10mg each morning) to protect my kidneys. I went on a low-carb diet, lost nearly 50 pounds and am now almost back to the weight I was in college. My blood-sugar tests are in the "excellent" range.About six months ago I started having coughing spells that seem to keep getting worse no matter what the doctor prescribes to control them. He's tried various antihistamines, antibiotics to treat bronchitis, and lots of different cough medicines. Right now I'm taking (500 mg twice a day), (10cc every four hours), and (every 12 hours). But the coughing spells last so long and are so violent that sometimes I almost pass out from them. I never cough anything up. Can you help me find out what is going on? This is totally ruining my life. Getty Images Can't stop coughing? ACE inhibitors may be to blame. A: Judging from what you've described, I'm almost certain that you have what I call an "ACE cough." The lisinopril you're taking is in a group of drugs called ACE (angiotensin-converting enzyme) inhibitors, which are typically prescribed to lower blood pressure and thus can lower the risk of , a type of progressive kidney disease that can occur in people with diabetes and eventually result in end-stage renal failure. In my experience, prescribers often place their diabetic patients on lisinopril just as a precaution. While that approach may have some merit with younger patients, the reduced renal function of older patients tends to negate all the possible benefits of ACE-inhibitor therapy.
Ask the Pharmacist
Information contained in the Ask the Pharmacist column by Dr. Armon B. Neel Jr. is intended to help individuals and their families become more informed about medication usage and interactions, and be better health care consumers. Any advice or information provided should not be followed in lieu of a personal consultation with a trained medical professional.One of the telltale adverse effects of ACE inhibitors, including lisinopril, is a chronic, hacking cough — a potential side effect that patients often don't hear about. Studies suggest that up to a third of all patients taking an ACE inhibitor will develop this type of chronic dry cough, and the cough often doesn't go away when they stop taking the drug. This happens more with women than with men, and more with African Americans and Asians than others. You might be wondering how a blood pressure drug could cause respiratory problems. ACE inhibitors affect the process of renal perfusion, which is how the kidneys filter impurities out of the blood. As an older person loses kidney function, the change is reflected in his or her glomerular filtration rate (GFR). The lower your GFR, the more difficult it is for your body to clear drugs from your kidneys and bloodstream, lowering their effectiveness and potentially causing them to accumulate at toxic levels in the body. In this case, the insoluble by-products of the drugs, called kinins, are not filtered out of the blood. They then flow out of the kidneys and lodge themselves in the lungs' bronchial tubes. The coughing spells represent the body's attempt to expel the kinins from the lungs. Even after the drug is stopped, the cough can linger for months until all the kinins eventually find their way out of the lungs.