Does losartan cause coughing
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Does Losartan Cause Cough?
Introduction to Losartan and Cough
Losartan is an angiotensin II receptor antagonist commonly used to treat hypertension. A frequent side effect of angiotensin-converting enzyme (ACE) inhibitors, another class of hypertension drugs, is a persistent dry cough. This article explores whether losartan, as an alternative to ACE inhibitors, also causes coughing.
Comparative Studies on Cough Incidence
Losartan vs. Lisinopril and Hydrochlorothiazide
Several studies have compared the incidence of cough in patients treated with losartan, lisinopril (an ACE inhibitor), and hydrochlorothiazide (a diuretic). In a multicenter, randomized, double-blind trial involving 135 patients with a history of ACE inhibitor-related cough, the incidence of cough was significantly lower in patients treated with losartan (29%) compared to those treated with lisinopril (72%) and similar to those treated with hydrochlorothiazide (34%) . This suggests that losartan is less likely to cause cough than lisinopril.
Mechanism of Cough Induction
The lower incidence of cough with losartan is attributed to its mechanism of action. Unlike ACE inhibitors, which increase bradykinin levels and can lead to cough, losartan does not affect bradykinin metabolism. This difference in pharmacological action likely explains the reduced cough incidence with losartan .
Clinical Observations and Case Studies
Losartan-Induced Cough
While losartan is generally associated with a lower incidence of cough, there are rare cases where patients have developed a cough after starting losartan. For instance, a case study reported a 23-year-old woman who developed a cough after beginning losartan treatment, which resolved after switching to the ACE inhibitor enalapril. Another rare case involved a patient who developed a severe cough leading to a rectus sheath hematoma, highlighting that although uncommon, losartan-induced cough can occur and may have serious consequences.
Animal Studies
Animal studies have also been conducted to compare the cough-inducing potential of losartan and lisinopril. In both anesthetized and awake rabbits, lisinopril significantly increased the cough response, whereas losartan did not, supporting the notion that losartan has a lower cough-inducing potential.
Conclusion
In summary, losartan is significantly less likely to cause cough compared to ACE inhibitors like lisinopril. This makes losartan a suitable alternative for patients who experience cough with ACE inhibitors. However, while rare, there are instances where losartan can induce cough, and these cases should be monitored closely. Overall, losartan represents a viable option for hypertensive patients who are intolerant to ACE inhibitors due to cough.
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