Losartan side effects cough
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Losartan and Cough: Understanding the Side Effects
Introduction to Losartan and Cough
Losartan, an angiotensin II receptor antagonist (ARA), is commonly prescribed for hypertension. Unlike angiotensin-converting enzyme inhibitors (ACEIs), which are well-known for causing a persistent dry cough, losartan is generally considered to have a lower incidence of this side effect. However, some studies have explored the occurrence of cough in patients treated with losartan, especially those with a history of ACEI-induced cough.
Comparative Studies on Cough Incidence
Losartan vs. ACE Inhibitors
Several studies have compared the incidence of cough between losartan and ACE inhibitors. A study involving over 9,000 patients found that while cough was the most frequent reason for discontinuation of losartan, the incidence was significantly lower compared to ACE inhibitors like enalapril, lisinopril, and perindopril. Another study confirmed that the incidence of dry cough was significantly higher in patients treated with lisinopril (72%) compared to those treated with losartan (29%) .
Losartan vs. Placebo
In a double-masked, randomized study, the incidence of dry cough in patients with a history of ACEI-induced cough was significantly higher in the lisinopril group (87.5%) compared to the losartan (36.7%) and placebo (31.4%) groups. The difference between losartan and placebo was not statistically significant, indicating that losartan's incidence of cough is comparable to that of a placebo.
Mechanisms and Patient Responses
Mechanism of Cough Induction
The mechanism behind ACEI-induced cough is believed to be related to the accumulation of bradykinin and substance P, which are not affected by ARBs like losartan. This difference in mechanism is why losartan generally has a lower incidence of cough .
Patient Case Studies
Interestingly, there are rare cases where patients have experienced cough with losartan. One case study reported a young woman who developed a cough after starting losartan, which resolved completely after switching to the ACE inhibitor enalapril. This suggests that while uncommon, losartan-induced cough can occur and may be resolved by switching medications.
Conclusion
Overall, losartan is associated with a significantly lower incidence of cough compared to ACE inhibitors, making it a suitable alternative for patients who develop cough with ACEIs. However, rare cases of losartan-induced cough do exist, highlighting the importance of individualized patient care and monitoring. For most patients, losartan offers an effective and well-tolerated option for managing hypertension without the common side effect of cough seen with ACE inhibitors.
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