Lisinopril Cough: Why It Happens and What to Do About It

Why Does Lisinopril Cause a Cough?

Lisinopril belongs to a class of medications called [ACE inhibitors](/drug-classes/ace-inhibitors) (angiotensin-converting enzyme inhibitors). ACE inhibitors block the enzyme that converts angiotensin I to angiotensin II — a potent vasoconstrictor. This mechanism lowers blood pressure and protects the kidneys and heart.

However, ACE also breaks down a substance called bradykinin. When ACE is inhibited, bradykinin accumulates in the lungs. Bradykinin stimulates sensory nerve fibers in the airways, triggering a persistent, dry, tickling cough that does not produce mucus. This is a class effect — it occurs with all ACE inhibitors, not just [lisinopril](/drugs/lisinopril).

How Common Is the Lisinopril Cough?

The ACE inhibitor cough affects approximately 10–15% of patients in Western populations and up to 30–40% of Asian patients (due to genetic differences in bradykinin metabolism). It is the most common reason patients stop taking ACE inhibitors.

The cough typically begins within the first few weeks of starting the medication, though it can develop at any time during treatment — even after years of tolerating the drug. It resolves within 1–4 weeks of stopping the ACE inhibitor.

How to Tell If Your Cough Is from Lisinopril

The lisinopril cough has characteristic features that distinguish it from other causes of cough:

• Dry, non-productive (no mucus or phlegm)
• Persistent and tickling — often described as a "tickle in the throat"
• Worse at night or when lying down
• Not associated with fever, cold symptoms, or shortness of breath
• Started after beginning lisinopril or another ACE inhibitor

If you have these features and are taking lisinopril, the cough is very likely drug-related. A trial of stopping the medication (with your doctor's guidance) that resolves the cough confirms the diagnosis.

What to Do About the Lisinopril Cough

There is no effective way to treat the ACE inhibitor cough while continuing the medication — the only solution is to switch to a different drug class. The most common alternatives are:

[ARBs](/drug-classes/arbs) (Angiotensin Receptor Blockers)

ARBs are the most common replacement for ACE inhibitors in patients who develop a cough. They block the angiotensin II receptor directly rather than inhibiting ACE, so bradykinin does not accumulate. ARBs have equivalent blood pressure lowering and cardiovascular protective effects to ACE inhibitors. Common ARBs include [losartan](/drugs/losartan) (Cozaar), valsartan (Diovan), irbesartan (Avapro), and olmesartan (Benicar). All are available as generics.

ARNIs (Sacubitril/Valsartan)

Sacubitril/valsartan (Entresto) combines an ARB (valsartan) with a neprilysin inhibitor. It does not cause cough and is preferred over ACE inhibitors for [heart failure](/conditions/heart-failure) with reduced ejection fraction. It is significantly more expensive than generic ARBs.

Other Blood Pressure Medications

If ARBs are not appropriate, calcium channel blockers (amlodipine, nifedipine) or thiazide diuretics (hydrochlorothiazide, chlorthalidone) are effective alternatives for [hypertension](/conditions/hypertension) without the cough risk.

Should You Stop Lisinopril Without Telling Your Doctor?

Do not stop lisinopril abruptly without consulting your prescriber. While stopping will resolve the cough, your blood pressure or heart condition requires ongoing treatment. Your doctor will need to prescribe an alternative medication before you stop lisinopril to ensure continuous protection.

References

1. Dicpinigaitis PV. Angiotensin-converting enzyme inhibitor-induced cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):169S-173S.
2. Israili ZH, Hall WD. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. Ann Intern Med. 1992;117(3):234-242.