Does losartan make you cough
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Does Losartan Cause Cough?
Introduction to Losartan and Cough
Losartan, an angiotensin II receptor antagonist, is commonly prescribed for hypertension. A frequent concern with antihypertensive medications, particularly angiotensin-converting enzyme (ACE) inhibitors, is the side effect of cough. This article explores whether losartan, as an alternative to ACE inhibitors, induces cough.
Incidence of Cough with Losartan vs. ACE Inhibitors
Several studies have consistently shown that losartan is associated with a significantly lower incidence of cough compared to ACE inhibitors like lisinopril. In a multicenter, randomized, double-blind trial involving 135 patients with a history of ACE inhibitor-related cough, the incidence of cough was significantly higher in patients treated with lisinopril compared to those treated with losartan or hydrochlorothiazide . Another study with 100 hypertensive patients also found that the incidence of dry cough was much higher in the lisinopril group (87.5%) compared to the losartan group (36.7%) and placebo group (31.4%) .
Comparative Studies on Cough Frequency
The frequency and severity of cough were also assessed in these studies. Patients treated with lisinopril reported a higher frequency of cough compared to those treated with losartan or hydrochlorothiazide, as measured by a visual analogue scale 123. This pattern was consistent across multiple studies, indicating that losartan is less likely to induce cough than ACE inhibitors.
Mechanism Behind Reduced Cough with Losartan
The lower incidence of cough with losartan can be attributed to its mechanism of action. Unlike ACE inhibitors, which increase bradykinin levels (a known cause of cough), losartan does not affect bradykinin metabolism. This distinction is crucial in understanding why losartan is less likely to cause cough .
Case Reports and Observational Studies
While the majority of studies support the notion that losartan does not significantly induce cough, there are rare case reports of losartan-induced cough. For instance, a case study reported a young woman who developed a cough after starting losartan, which resolved after switching to the ACE inhibitor enalapril . However, such cases are exceptions rather than the norm.
Conclusion
In summary, losartan is associated with a significantly lower incidence and frequency of cough compared to ACE inhibitors like lisinopril. This makes losartan a preferable option for hypertensive patients who experience cough with ACE inhibitors. While rare cases of losartan-induced cough exist, they are not common enough to outweigh the benefits of switching from an ACE inhibitor to losartan for patients troubled by cough.
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