In my experience, prescribers often place their diabetic patients on lisinopril just as a precaution. While that approach may have some merit with younger patients, the reduced renal function of older patients tends to negate all the possible benefits of ACE-inhibitor therapy. Information contained in the Ask the Pharmacist column by Dr. Armon B.
Neel Jr. Any advice or information provided should not be followed in lieu of a personal consultation with a trained medical professional. One of the telltale adverse effects of ACE inhibitors, including lisinopril, is a chronic, hacking cough — a potential side effect that patients often don't hear about.
Studies suggest that up to a third of all patients taking an ACE inhibitor will develop this type of chronic dry cough, and the cough often doesn't go away when they stop taking the drug.
This happens more with women than with men, and more with African Americans and Asians than others. You might be wondering how a blood pressure drug could cause respiratory problems. ACE inhibitors affect the process of renal perfusion, which is how the kidneys filter impurities out of the blood. As an older person loses kidney function, the change is reflected in his or her glomerular filtration rate GFR.
The lower your GFR, the more difficult it is for your body to clear drugs from your kidneys and bloodstream, lowering their effectiveness and potentially causing them to accumulate at toxic levels in the body. In this case, the insoluble by-products of the drugs, called kinins, are not filtered out of the blood. They then flow out of the kidneys and lodge themselves in the lungs' bronchial tubes. The coughing spells represent the body's attempt to expel the kinins from the lungs.
Even after the drug is stopped, the cough can linger for months until all the kinins eventually find their way out of the lungs. You can save on eye exams, prescription drugs, hearing aids and more.
Many of the patients I see with this problem are being treated for sinusitis, bronchitis, sore throat, laryngitis, asthma and many other respiratory conditions that are all a result of the ACE-inhibitor therapy. I recommend that you talk with your doctor or other health care provider about stopping the lisinopril.
You should be aware that angiotensin receptor blockers ARBs are chemically very similar to the ACE inhibitors and can produce the same problem. To ease the cough, you could continue on the Tessalon Perles until it clears or try dextromethorphan Delsym , an over-the-counter cough medicine, at one teaspoon every six hours, as needed. However, in people with advanced heart disease, ACE inhibitors are known to reduce the overall risk of death, while ARBs are not.
By weighing the pros and cons of a medication switch, you can make the right choice. The only way to treat ACE inhibitor-related cough is to stop treatment and switch to another type of drug. But this is not always possible, and you and your healthcare provider will need to weigh the benefits and risks to determine if changing is the right option. One of the more common side effects of ACE inhibitors is a persistent dry cough.
The same activity that allows ACE inhibitors to lower blood pressure can cause other substances, like bradykinin, to accumulate in the airways.
In some people, this can trigger airway inflammation and coughing. The only way to treat an ACE inhibitor-related cough is to stop treatment, but this is not always an option. Though a similar type of drug called an ARB can also treat high blood pressure, it may not be the right choice for people with advanced heart disease or other severe medical conditions.
While taking ACE inhibitors, make sure to regularly monitor your blood pressure, follow-up with your healthcare provider, and contact them if you experience any side effects—cough or otherwise. If the cough is affecting your quality of life, ask your healthcare provider if switching to another type of medication is a reasonable option.
Stopping an ACE inhibitor can cause your blood pressure to spike and increase your risk of heart attack and stroke. The abrupt discontinuation can also cause anxiety and an increased heart rate.
Never stop taking an ACE inhibitor or adjust the dose without first speaking with your healthcare provider. Looking to start a diet to better manage your high blood pressure? Our nutrition guide can help. ACE inhibitors. In: StatPearls [Internet]. Updated July 8, Incidence of discontinuation of angiotensin-converting enzyme inhibitors due to cough, in a primary healthcare centre in Singapore.
Singapore Med J. Angiotensin-converting enzyme inhibitors induce cough. Turk Thorac J. Angiotensin-converting enzyme inhibitors vs. Am Fam Physician. The effects of antitussive treatment of ACE inhibitor-induced cough on therapy compliance: a prescription sequence symmetry analysis. Drug Saf. Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data.
We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes. Table of Contents View All. A dry, tickly and often bothersome cough is the most common adverse effect of ACE inhibitors. In half of these patients, the ACE inhibitor has to be discontinued. Cough has emerged as a class effect occurring with all ACE inhibitors with no clear difference between the single substances.
0コメント