When Will Doctors Pay Attention to an ACE Cough?

We are dumbfounded! No one gets out of medical school without learning about a class of blood pressure medications called ACEi (angiotensin converting enzyme inhibitors). These are among the most commonly prescribed drugs in the pharmacy. We estimate that roughly 100 million prescriptions are filled each ear for drugs like:

Captopril (Capoten)
Benazepril (Lotensin)
Enalapril (Vasotec)
Fosinopril (Monopril)
Lisinopril (Prinivil, Zestril)
Moexipril (Univasc)
Perindopril (Aceon)
Quinapril (Accupril)
Ramipril (Altace)
Trandolapril (Mavik)

Lisinopril, for some reason, has captured physicians' fancy. It dominates all other ACE inhibitors by a wide margin, grabbing 70,000,000 prescription annually. To give you some sense of comparison, the best selling brand name drug in America is Lipitor. At last count, it was "only" dispensed about 50 million times. That is probably why we get so many comments about lisinopril and its major complication.

One of the most common side effects of all these medications is a cough (Annals of Internal Medicine, Jan. 1, 2008; Chest [suppl], Jan, 2006). The medical literature confirms that from 5 to 35 percent of patients will develop a nasty cough while taking an ACEi. And that may be a low estimate. And after stopping an ACEi it may take anywhere from 4 weeks to 3 months for the cough to finally disappear. No amount of cough medicine can quell this kind of cough. The only solution is usually to change to a completely different kind of blood pressure medication. Going from lisinopril to ramipril won't solve the problem!

This is not rocket science, folks. This is as basic as it gets. We continue to be astonished that so many people have posted to this Web site that their physicians have not acknowledged that their cough is caused by an ACE inhibitor like lisinopril. That is like banging your thumb with a hammer and not realizing why it hurts and why the nail turns black.

The most recent comment comes from Ann. We share her story with you just so you will understand that we couldn't make this stuff up if we tried. What really worries us, though, is that if some physicians can't seem to connect the dots when it comes to lisinopril and cough, what other drug-induced side effects are they missing? To read other comments on this ACEi cough, click here.