What Is a Lisinopril Cough?

Dry cough is a common side effect of ACE inhibitors

Updated on May 16, 2023

Medically reviewed by Rafle Fernandez, MD

A persistent dry cough is a common side effect of lisinopril, a drug commonly used to treat high blood pressure and heart failure. Sold under the brand names Zestril, Privnil, and others, lisinopril belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors which list a dry cough as a common side effect.

This article will explain the causes of a lisinopril cough, how likely it is to occur, and what you can do if you experience coughing while taking an ACE inhibitor.

Verywell / Theresa Chiechi

How Common Is Lisinopril Cough?

A cough is a relatively common occurrence with lisinopril as it is with all other ACE inhibitors, including:

Accupril (quinapril)
Altace (ramipril)
Capoten (captopril)
Lotensin (benazepril)
Mavik (trandolapril)
Monopril (fosinopril)
Univasc (moexipril)
Vasotec (enalapril)

According to the pre-market studies, 2.5% of people treated with lisinopril for hypertension (high blood pressure) reported coughing as a side effect.

With that being said, different groups of people are more vulnerable to this side effect. In some studies, up to 35% of users reported a persistent dry cough when taking ACE inhibitors. In around 20% of cases, a lisinopril cough is bad enough to require medical treatment.

Are All ACE Inhibitors the Same?

There is currently no evidence that one ACE inhibitor is less likely or more likely to cause a cough than another.

Why Does Lisinopril Cough Happen?

A lisinopril cough is caused by the mechanism of action of ACE inhibitors. The drugs function as vasodilators, meaning that they dilate (widen) blood vessels so that blood flow can be increased. By increasing blood flow, blood pressure is decreased.

ACE inhibitors like lisinopril work by blocking a substance called angiotensin-converting enzyme. Without this enzyme, the body cannot convert an inactive protein called angiotensin I into the active protein angiotensin II, Angiotensin II is the protein responsible for vasoconstriction, or the narrowing of blood vessels.

But angiotensin II has other functions in the body. Among them, it breaks down a compound called bradykinin that the body uses to instigate inflammation. By decreasing angiotensin II levels, ACE inhibitors allow bradykinin levels to increase.

In the airways, the accumulation of bradykinin triggers bronchoconstriction, or the narrowing of the airways. A persistent, dry cough is the consequence.

The onset of a lisinopril cough can occur within hours of taking the first dose to weeks or even months later. The symptom often gets worse at night.

Risk Factors for Lisinopril Cough

Most people who take Lisinopril or other ACE inhibitors do not develop a cough. Scientists are not sure why some people get a lisinopril cough and others don't, but there are certain factors that appear to increase a person's risk, including:

Older age
Female sex
Being a non-smoker
Airway hyperactivity, such as caused by asthma or chronic obstructive pulmonary disease (COPD)

Having one risk factor is usually not enough to cause a lisinopril cough. Most people who get a cough while taking ACE inhibitors have multiple risk factors.

Can Lisinopril Cough Be Treated?

A cough suppressant will not help with a lisinopril cough because it doesn't temper the underlying inflammation. The only way to treat a lisinopril cough is to stop taking the drug (and potentially all other ACE inhibitors).

However, that may not be a reasonable option. You'll need to talk to your healthcare provider to weigh the benefits of treatment against the possible risks and consequences. Unless coughing is significantly undermining your quality of life, the "pros" may outweigh the "cons."

In the United States, ACE inhibitors are regarded as the first-line option for treating hypertension and heart failure. Even so, another class of drugs called angiotensin II receptor blockers (ARBs) may be used in their place if you are truly intolerant to ACE inhibitors.

Research has shown that people taking ARBs are less likely to get a cough because they have no direct effect on bradykinin levels. At the same time, ARBs appear to be just as effective in reducing the risk of heart disease and death among people with high blood pressure when compared to ACE inhibitors.

Even so, ACE inhibitors are considered superior in preventing atherosclerosis (hardening of the arteries) and thrombosis (blood clots).

Rather than switching from ACE inhibitors to ARBs, some studies suggest that adding a calcium channel blocker like Norvasc (amlodipine) or Procardia (nifedipine) may help clear the cough in some people. Calcium channel blockers, also used to treat hypertension, appear to inhibit the production of prostaglandins such as bradykinin.

Summary

A persistent dry cough is a possible side effect of ACE inhibitors like lisinopril (Zestril, Privnil). The same action that makes ACE inhibitors effective in lowering blood pressure can cause an inflammatory substance known as bradykinin to build up in the airways and cause coughing.

The only way to treat a lisinopril cough is to stop taking the drug. However, you need to weigh the benefits and risks with your healthcare provider before deciding to do so.

If you can't cope with a lisinopril cough, your provider might decide to switch you to an angiotensin II receptor blocker (ARB) or add a calcium channel blocker to your treatment plan.

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