Medications that cause cough
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Medications That Commonly Cause Cough
Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors) and Cough
ACE inhibitors are the most well-known class of medications that can cause cough. The cough is usually dry and persistent, and its incidence ranges from about 1.5% to 35% in patients taking these drugs. The cough can start within hours of the first dose or even months after starting therapy. The most accepted explanation is that ACE inhibitors increase levels of bradykinin and substance P, which can trigger the cough reflex. Stopping the medication usually resolves the cough within 1 to 4 weeks, but it can sometimes last up to 3 months after discontinuation. Genetic factors may also play a role in who develops this side effect, with certain gene polymorphisms increasing risk 1234.
Angiotensin Receptor Blockers (ARBs) and Other Medications
While ARBs are often used as alternatives to ACE inhibitors, they can also rarely cause cough, though the risk is much lower compared to ACE inhibitors. Other medications that have been reported to cause cough include omeprazole (a proton pump inhibitor) and leflumide (an immunosuppressant), though these are much less common causes 12.
Inhaled Medications and Cough
Inhaled pharmaceutical products, such as certain bronchodilators and corticosteroids, can provoke cough as a side effect. The cough may be triggered by the drug itself, the inhaler device, or the formulation characteristics (such as pH, tonicity, or particle size). Inflammatory mediators released in the airways can also make cough receptors more sensitive, increasing the likelihood of cough with inhaled medications .
Over-the-Counter (OTC) Cough Remedies and Adverse Effects
OTC cough medications, including codeine, antihistamines, and mucolytics, are widely used to treat cough. However, there is limited evidence supporting their effectiveness, especially in children. Some of these medications can cause side effects, and inappropriate use may lead to accidental overdosing or adverse events. In children, codeine and antihistamines are generally not recommended due to safety concerns 89.
Other Drug Classes and Cough
Other drugs, such as certain antibiotics, nasal corticosteroids, and antihistamines, are sometimes prescribed to treat cough, especially in patients with underlying lung diseases. However, these medications are not always effective, and some may even contribute to persistent cough or other side effects .
Conclusion
ACE inhibitors are the most common medications known to cause cough, with ARBs, some proton pump inhibitors, and certain immunosuppressants also implicated, though less frequently. Inhaled medications can provoke cough due to their formulation or delivery method. Over-the-counter cough remedies may not be effective and can cause adverse effects, especially in children. When evaluating a patient with chronic cough, it is important to review their medication history and consider drug-induced cough as a possible cause after ruling out more common conditions 1234+3 MORE.
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