Medications associated with cough
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Medications Commonly Associated with Cough
Several medications are known to be associated with cough, either as a side effect or as part of their intended therapeutic action. The most well-documented drug class linked to cough is the angiotensin-converting enzyme inhibitors (ACE inhibitors), but other medications and over-the-counter (OTC) preparations can also be involved.
ACE Inhibitors and Cough
ACE inhibitors, such as captopril, enalapril, lisinopril, ramipril, cilazipril, and quinapril, are widely recognized for causing cough in a significant proportion of patients—estimates range from 5% to 35% of those treated. The cough is typically dry, persistent, and nonproductive, often described as a tickling sensation. It can begin within hours to months after starting therapy and usually resolves within 1 to 4 weeks after stopping the medication, though it may persist for up to 3 months in some cases. The mechanism is believed to involve the accumulation of bradykinin and substance P, which are normally broken down by ACE, as well as increased prostaglandin production. The only consistently effective treatment is discontinuing the ACE inhibitor, as switching to angiotensin receptor blockers (ARBs) rarely causes the same issue Shim2020Ding2020Just1989+1 MORE.
Other Prescription Medications Linked to Cough
While ACE inhibitors are the most common culprits, other drugs have also been reported to cause cough. These include:
- Angiotensin receptor blockers (ARBs), though the risk is much lower compared to ACE inhibitors.
- Omeprazole and leflunomide, which have been reported in rare cases to induce chronic cough.
- Some antitussive drugs and bronchodilators, though evidence is limited and less consistent .
Over-the-Counter (OTC) Cough Medications
OTC cough medicines, including antitussives (like dextromethorphan), expectorants (such as guaifenesin), mucolytics, antihistamines, and antihistamine-decongestant combinations, are frequently used to treat acute cough. However, studies show mixed results regarding their effectiveness, and some preparations—especially those containing antihistamines and dextromethorphan—are associated with a higher rate of adverse effects, including cough or worsening of cough symptoms. In children, these medications are generally no more effective than placebo and can sometimes cause harm Smith2014Smith2008.
Opioid Antitussives and Side Effects
Opioid-based antitussives, such as codeine and morphine, are effective in suppressing cough but are associated with side effects like drowsiness, nausea, constipation, and risk of dependence. These side effects can sometimes include paradoxical cough or respiratory complications, especially with misuse or in sensitive individuals Chung2005Zanasi2020.
Emerging Therapies and Cough Receptors
Newer drugs targeting specific cough receptors, such as P2X3 receptor antagonists and modulators of transient receptor potential (TRP) channels, are being developed for refractory or unexplained chronic cough. These therapies aim to reduce cough by acting on the sensory pathways that trigger the cough reflex, potentially offering relief with fewer side effects than traditional medications Guilleminault2024Dicpinigaitis2020.
Conclusion
Cough is a common side effect of several medications, most notably ACE inhibitors, but can also occur with other prescription drugs and OTC cough remedies. The risk and mechanism vary by drug class, with ACE inhibitors being the most frequently implicated. Awareness of medication-induced cough is important for diagnosis and management, especially when other common causes have been excluded. New therapies targeting cough receptors may offer future alternatives with improved safety profiles.
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Most relevant research papers on this topic
Over-the-counter (OTC) medications for acute cough in children and adults in community settings.
OTC medications for acute cough in adults and children show mixed results, with mucolytics showing the most benefit and honey being more effective than placebo.
Over-the-counter medications for acute cough in children and adults in ambulatory settings.
There is no clear evidence for or against the effectiveness of over-the-counter medicines in acute cough, with conflicting results and uncertainty regarding clinical relevance.
Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines.
ACE inhibitors can cause chronic cough, and stopping the medication is the only uniformly effective treatment, but some pharmacologic agents may help reduce the cough.
Pharmacological Therapy of Acute and Chronic Cough
Antitussive drugs and neuromodulator drugs are effective in treating acute and chronic cough, but their effectiveness depends on identifying the cause and implementing a symptomatic treatment approach.
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