Why does bradykinin cause dry cough

Stark RD. Arch Intern Med. Coronavirus Resource Center. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Twitter Facebook. This Issue. June Ronald D. This may also cause cough reflex hypersensitivity. Another more serious adverse effect that has been associated with the use of ACE inhibitors, angioneurotic oedema, may be related to the same mechanisms.

Management: The dry cough almost always disappears upon withdrawal of the specific drug. In some instances a dose reduction may lead to improvement. Recent reports have suggested that treatment with calcium antagonists nifedipine or non-steroidal anti-inflammatory drugs indomethacin and sulindac may eliminate the cough.

In some cases, the cough may be mild, but sometimes it may be bad enough that you need to change treatment. This article looks at what causes an ACE inhibitor-related cough, who is most likely to be affected, and what you can do if it occurs.

A persistent dry cough is a side effect associated with all ACE inhibitors. The coughing can develop within hours of the first dose or even weeks or months later. Examples of ACE inhibitors include:. All ACE inhibitors have the potential to cause coughing. As many as one in five users may be affected, although most do not need to change medications because of it. ACE inhibitors work by blocking an enzyme called angiotensin II that causes vasoconstriction the narrowing of blood vessels.

This narrowing can cause high blood pressure and forces the heart to work harder. Although vasoconstriction is a normal process that helps regulate blood flow, it can be a problem in people with high blood pressure. By relaxing blood vessels and increasing blood flow, blood pressure can be reduced.

However, angiotensin II also has other functions that can indirectly cause coughing in some people. Angiotensin II breaks down a substance called bradykinin. When angiotensin II is blocked, bradykinin can begin to build up in the airways. The build-up can trigger an inflammatory reaction and a persistent tickly sensation in the chest and throat.

In some people, this can lead to severe, hacking coughs. Taking ACE inhibitors can lead to an increase in a substance called bradykinin. This can irritate the airways, triggering inflammation and coughing. The majority of people who take ACE inhibitors do not develop a cough. It is not clear why some people develop coughs and others do not, but there are certain factors that can increase the risk, including:.

One of these factors alone is usually not enough to cause an ACE inhibitor-related cough. A combination of two or more is needed. A cough caused by ACE inhibitors can only be treated by stopping the drug.

With that said, you should never stop treatment without first talking to your healthcare provider. Depending on your circumstances, the benefits of treatment may outweigh the concerns.

At the same time, your cough may also have nothing to do with the ACE inhibitor. Further testing may be needed to find the cause. If you develop a cough while taking an ACE inhibitor, it's important to speak with your healthcare provider and discuss whether switching to another medication is a good idea. It may or may not be. Start by asking yourself:. If you and your healthcare provider decide that the side effect is intolerable, you can explore whether a similar type of drug called an angiotensin II receptor blocker ARB can be used instead.

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.