Cough with ACE inhibitors

Angiotensi n-converti ng Hypotension, cough (with ACE inhibitors), BP every 2 hours x 3 for first dose, then every shift during oral... 

ACE) inhibitors, such as captopril. Up to 20% of these patients may develop a cough with ACE inhibitors. The cause is not known for certain, but it may be related to the accumulation in the lungs of bradykinin or other inflammatory mediators. Inhibiting ACE leads to an increase in bradykinin, which is normally broken down by this enzyme. The rash was originally attributed to a sulfhydryl group in captopril but is known to occur with other non-sutfhydryl-containing ACE-inhibitors. 

Potential disadvantages are burning stinging pain and hyperalgesia at the injection site possible neurotoxicity if injected directly into a nerve. Persistent redness and erythema occasional cough with ACE inhibitors... 

Angiotensin receptor blockers show similar tolerability to ACE inhibitors with regard to hypotension and hyperkalemia, but they do not induce cough since ARBs do not cause an accumulation of bradykinin. Angiotensin receptor blockers can be considered in patients with ACE inhibitor-induced angioedema, but they should be initiated cautiously, as crossreactivity has been reported. Many of the other considerations for the use of ARBs are similar to those of ACE inhibitors,... 

An angiotensin receptor blocker may be prescribed for patients with ACE inhibitor cough and a low LVEF and heart failure after MI. Example doses include the following ... 

ARBs appear to have the lowest incidence of side effects compared with other antihypertensive agents. Because they do not affect bradykinin, they do not cause a dry cough like ACE inhibitors. Like ACE inhibitors, they may cause renal insufficiency, hyperkalemia, and orthostatic hypotension. Angioedema is less likely to occur than with ACE inhibitors, but crossreactivity has been reported. ARBs should not be used in pregnancy. 

Angiotensin II blockers are likewise well tolerated these drugs do not cause the cough associated with ACE inhibitors.64 Hence, angiotensin II blockers may be an effective alternative in patients who experience side effects such as coughing.13... 

Adverse effects These include postural hypotension, renal insufficiency, hyperkalemia, and a persistent dry cough. The potential of symptomatic hypotension with ACE inhibitor therapy requires careful monitoring. ACE inhibitors should not be used in pregnant women. 

Use alternative anti hypertensive medications if possible (e.g. replace beta-blockers and calcium channel blockers with ACE inhibitors or angiotensin II receptor blockers if bradycardia is worsened, and replace ACE inhibitors with angiotensin II receptor blockers if cough is worsened)... 

A compilation of three controlled trials in 1200 patients showed incidence rates of cough of 3.6% with valsartan versus 9.5% with ACE inhibitors and 0.4% with placebo (1). 

A non-productive irritant cough is associated with ACE inhibitors (28,29). The dose-relatedness of this adverse effect is not clear. 

Valsartan (Diovan) 80-320 1 failure in patients with severe bilateral renal artery stenosis or severe stenosis in artery to solitary kidney do not cause a drug cough like ACE inhibitors may do not use in pregnancy... 

Besides hypotension, the most frequent adverse reaction to an ACE inhibitor is cough, which may occur in up to 30% of patients. Patients with ACE inhibitor cough and either clinical signs of heart failure or LVEE less than 40% may be prescribed an angiotensin-receptor blocker (ARB). Both candesartan and valsartan have improved outcomes in clinical trials in patients with heart failure. Other less common but more serious adverse effects of ACE inhibitors include acute renal failure, hyperkalemia, and angioedema. Although some data have suggested that aspirin use may decrease the benefits from ACE inhibitor treatment, a systematic review of more than 20,000 patients demonstrated that ACE inhibitors improve outcome irrespective of treatment with aspirin. ... 

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