Ace Inhibitors and Coughing?
I’ve been on Enalapril for 2 months – it seems to be working really well. My BP was quite high (up and down) and now it’s pretty stable. However, the last few weeks I’ve been having a cough. I do have a little bronchitis right now but I’m afraid that isn’t what is causing it. I’ve also been taking cough syrup every few hours. If it is the cough caused by my BP med would the cough medicine work? As it doesn’t seem to be working does that mean it’s likely the BP meds?
If this is the Enalapril what would my options be? I know they didn’t want to put me on a Beta Blocker because I already have an illness that causes fatigue and they didn’t want me to have more. Is it possible that this will go away?
Thanks!
Dry cough is a possible side effect of ACE inhibitors. If you’re coughing anything up it’s something else. If the cough is caused by the ACE, it may go away if you give it time. If it doesn’t get better and you can’t tolerate it then see your doctor. There are many options for blood pressure control other than beta blockers. But you have to weigh the pros and cons of any treatment. Beta blockers might not cause you to be more fatigued at all so don’t knock it before you try it…
Enalapril is a great medication in the ACE-inhibitor category. This class of medications works through inhibiting angiotensin converting enzyme from converting angiotensin 1 to angiotensin 2. As a side effect, it also prevents breakdown of a chemical called bradykinin, which may lead to coughing. This side effect may manifest immediately after starting the medication or may onset much later, so it is difficult to interpret causation of coughing based on timing of therapy onset.
Cough can be caused by many different things. If you have a bronchitis, that is certainly a reason to have a cough. If this is the cause, the cough medications available over the counter should help suppress the cough. Unfortunately, none of these medications are really a ’silver bullet’ so you shouldn’t expect immediate improvement of the cough. If the cough persists for more than 2 weeks and the rest of your bronchitis symptoms have resolved, then I would consider enalapril as the culprit.
If enalapril is the cause of your cough, you have several options. You can try a different ACE inhibitor such as benazepril or lisinopril or captopril. They work through the same basic mechanism but sometimes people will respond better to a different agent. More than likely, however, you will continue to have a cough. An alternative that would work great is a medication in the ARB category, such as valsartan or losartan. These medications have a similar end effect as ACE inhibitors because they function to block angiotensin 2 at the end receptor, but don’t affect bradykinin levels and thus avoid the cough side effect. The only problem with these agents is that they are newer, and as such they are more expensive and less studied.
Overall, I would hold off for a few weeks and see if the cough will resolve on its own. Then, I’d consult with a physician to investigate the cause of the cough (e.g., post-nasal drip, post-viral cough, GERD, etc). If your physician believes it is a drug side effect, then he or she can advise you on how to proceed and what alternative medication may benefit you. I strongly discourage changing medications or stopping medications without first consulting your personal physician!
I had the same issue…the cough went away after a month or two…