How to treat lisinopril cough
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Treating Lisinopril-Induced Cough: Effective Alternatives and Strategies
Introduction to Lisinopril-Induced Cough
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is commonly prescribed for hypertension and heart failure. However, a significant side effect associated with its use is a persistent dry cough. This adverse effect can be troublesome for patients, leading to discontinuation of the medication. Understanding alternative treatments and strategies to manage this cough is crucial for patient compliance and overall health outcomes.
Alternatives to Lisinopril: Angiotensin II Receptor Antagonists
Valsartan as an Alternative
Research indicates that switching to angiotensin II receptor antagonists (ARBs) like valsartan can significantly reduce the incidence of cough. In a study comparing valsartan, lisinopril, and hydrochlorothiazide, the occurrence of a dry, persistent cough was significantly lower with valsartan (19.5%) compared to lisinopril (68.9%). This suggests that valsartan is a viable alternative for patients experiencing lisinopril-induced cough.
Losartan: A Promising Substitute
Losartan, another ARB, has also been shown to have a lower incidence of cough compared to lisinopril. Multiple studies have demonstrated that patients treated with losartan experienced significantly fewer cough episodes than those treated with lisinopril . For instance, one study reported that the incidence of cough was 36.7% with losartan compared to 87.5% with lisinopril. This makes losartan a strong candidate for patients who need to switch from lisinopril due to cough.
Telmisartan: Comparable to Placebo
Telmisartan, a novel ARB, has been found to have a cough incidence comparable to placebo. In a study involving patients with mild to moderate hypertension, the incidence of cough was significantly lower with telmisartan (15.6%) compared to lisinopril (60%). This further supports the use of ARBs as effective alternatives to ACE inhibitors like lisinopril.
Mechanistic Insights: Why ARBs Cause Less Cough
The lower incidence of cough with ARBs compared to ACE inhibitors can be attributed to their different mechanisms of action. ACE inhibitors increase bradykinin levels, which can lead to cough, whereas ARBs do not affect bradykinin levels. This mechanistic difference is supported by animal studies showing that lisinopril, but not losartan, significantly increased the cough response in both anesthetized and awake rabbits.
Conclusion
For patients experiencing a persistent dry cough due to lisinopril, switching to an angiotensin II receptor antagonist such as valsartan, losartan, or telmisartan can significantly reduce the incidence of cough while maintaining effective blood pressure control. These alternatives offer a promising solution for managing lisinopril-induced cough, improving patient compliance and overall treatment outcomes.
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