ACE Inhibitor Cough: What It Is and How to Deal With It

If you’ve been prescribed an ACE inhibitor for high blood pressure or heart failure, you might have noticed a persistent dry cough. You’re not alone – about 5‑10 % of people on these drugs develop this annoying symptom. The good news is that the cough isn’t dangerous, and there are clear ways to reduce or eliminate it.

What triggers the cough?

ACE inhibitors block an enzyme called angiotensin‑converting enzyme. This enzyme also breaks down a molecule called bradykinin. When the enzyme is blocked, bradykinin builds up in the lungs and airways. The extra bradykinin irritates the lining of the throat, leading to a dry, tickly cough that often worsens at night.

Unlike a cough caused by a cold or allergies, the ACE‑inhibitor cough usually doesn’t produce mucus. It can start weeks after you begin the medication and may linger as long as you stay on the drug. Switching to a different blood‑pressure medicine often makes the cough disappear within a few days.

How can you manage the cough?

First, confirm that the medication is the cause. Talk to your doctor if the cough started after you began an ACE inhibitor and there are no other obvious reasons. Your doctor may suggest one of these steps:

• Switch to an ARB. Angiotensin‑II receptor blockers (like losartan or valsartan) work similarly to ACE inhibitors but don’t raise bradykinin levels, so the cough usually stops.
• Adjust the dose. A lower dose may reduce the cough while still controlling blood pressure.
• Try a short‑term cough suppressant. Over‑the‑counter options like dextromethorphan can help you sleep, but they won’t fix the underlying cause.

If you can’t switch drugs right away, keep the throat moist. Warm teas, honey, and humidifiers can soothe irritation. Avoid smoking and strong fragrances, which can make the cough worse.

Lastly, never stop a prescribed medication without talking to your healthcare provider. Stopping an ACE inhibitor abruptly can raise blood pressure and increase heart‑failure risk. Your doctor will guide you to a safe alternative and monitor your progress.

Bottom line: an ACE inhibitor cough is a common, non‑life‑threatening side effect caused by bradykinin buildup. Recognizing the pattern, confirming the cause, and working with your doctor to switch to an ARB or adjust the dose usually ends the cough quickly. Stay proactive, keep your doctor in the loop, and you’ll find a blood‑pressure solution that doesn’t keep you up at night.