Medications that cause cough

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Medications That Cause Cough: An Overview

Introduction to Drug-Induced Cough

Cough is a common reflex that serves as a defensive mechanism for the respiratory system. However, it can also be a side effect of various medications, leading to discomfort and impacting the quality of life. Understanding which medications can induce cough and the mechanisms behind this side effect is crucial for effective patient management.

Angiotensin-Converting Enzyme Inhibitors (ACEIs)

ACEIs and Cough Mechanism

Angiotensin-converting enzyme inhibitors (ACEIs) are well-documented for causing a persistent, dry cough in a significant number of patients. The incidence of ACEI-induced cough ranges from 5% to 35% among users. The mechanism is believed to involve the accumulation of bradykinin and substance P, which are normally degraded by ACE. When ACE is inhibited, these protussive mediators accumulate in the respiratory tract, leading to cough.

Clinical Implications

The onset of ACEI-induced cough can vary from hours to months after starting the medication, and resolution typically occurs within 1 to 4 weeks after discontinuation, although it can take up to 3 months in some cases. The only effective treatment is stopping the ACEI, although some pharmacologic agents may help attenuate the cough.

Angiotensin Receptor Blockers (ARBs)

ARBs and Cough

While angiotensin receptor blockers (ARBs) are often considered as alternatives to ACEIs, they can also cause cough, albeit less frequently. The incidence of cough with ARBs is similar to that of control drugs, making them a viable option for patients who develop cough with ACEIs .

Other Medications

Proton Pump Inhibitors (PPIs) and Leflunomide

There are reports of other medications, such as proton pump inhibitors (PPIs) like omeprazole and the immunosuppressant leflunomide, causing chronic cough. These cases are less common but should be considered, especially when other common causes of chronic cough have been excluded.

Inhalation Pharmaceuticals

Inhalation pharmaceutical products can also induce cough. Factors such as the type of inhaler device, drug formulation, dose, and excipients can trigger cough by stimulating cough receptors in the airways. This is particularly problematic in patients with bronchoconstriction, as it reduces drug deposition in the target pulmonary regions.

Conclusion

Drug-induced cough is a significant clinical issue, particularly with medications like ACEIs and, to a lesser extent, ARBs, PPIs, and certain inhalation products. Understanding the mechanisms and identifying the offending agents are crucial steps in managing and mitigating this side effect. Discontinuation of the causative drug is often the most effective solution, although alternative treatments and pharmacologic agents may provide relief in some cases.