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One of the most prestigious academic medical centers in the US was involved in a study to evaluate diagnostic errors (BMJ Quality & Safety (Oct. 1, 2024). The results were mind boggling. Mistakes were common…roughly 1 in 14 patients were misdiagnosed. Another study published in JAMA Internal Medicine (Feb. 1, 2024) analyzed data from 29 hospitals. The researchers examined medical records after people were transferred to intensive care units (ICUs) or died. Error rates ranged from 5% to 25%. These were serious medical conditions that were misdiagnosed. What about something “simple” like a cough? How often does that get misdiagnosed? What if its the “COUGH FROM HELL“? You may be surprised to learn how often this serious drug-induced cough may missed.
A Reader Shares her experience with the cough from hell:
Q. I have had the cough from hell with retching and even vomiting for six months now.
The first doctor suggested I have a “post-viral hyper-reactive cough.”
The second recommended drugs for acid reflux and the third prescribed an inhaler for asthma; neither of those worked. I then begged for a test for whooping cough, which was negative.
sI’ve now been referred to an ENT for a nasopharyngeal camera.
My husband keeps asking me if I can just suppress the cough. No!
Today I read on your website that this cough of death could be caused by ACE inhibitors. I take ramipril for blood pressure, and it is an ACE inhibitor. I will phone my GP in the morning and ask to be put on a completely different type of blood pressure tablet.
Why in heaven’s name is this paroxysmal, vomit-inducing cough not properly listed as a side effect of ramipril? I would not wish this horrific cough on my worst enemy.
A. We are shocked but not surprised that your doctors did not warn you about an ACE inhibitor cough. Although it is a relatively common side effect of drugs with “pril” in their names like benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril or spirapril, we have heard from many people that they were never warned about the cough from hell.
How Many People Take Prils for High Blood Pressure?
ACE inhibitors are very effective and safe blood pressure medicines for most people, but a sizable minority experience the kind of cough from hell that you are describing. According to our calculations, over 20 million Americans take lisinopril alone. Millions more take a different ACE inhibitor or a combination blood pressure medicine that contains an ACEi.
Researchers have estimated that anywhere from 5 to 35 percent of patients will develop an uncontrollable cough because of an ACE inhibitor (Annals of Internal Medicine, Jan. 1, 2008; Chest [suppl], Jan, 2006). That means that millions of people could be suffering as you have.
A study published in the Journal of Clinical Hypertension (July, 2023) reports that ramipril has the worst track record when it comes to coughing. It is followed by fosinopril and lisinopril. The two ACE inhibitors that were least likely to trigger a cough were captopril and spirapril.
What is so puzzling and frustrating is that 1) so many doctors do not warn about this side effect when they write a prescription and 2) so many doctors seem to ignore the blood pressure medicine as a cause of cough. Far too many patients are worked up for allergies, asthma or some other condition when what they really need is a different blood pressure medicine
Readers Who Also had the Cough from Hell:
M.O.B. shared her husband’s experience:
“My poor husband has suffered for 3 years with this dreadful debilitating cough which our doctor said was not related to ramipril, because that is a dry, irritating cough, usually in the afternoon; not a productive, frothy, eye-watering, vomit-making, eye -popping cough every morning!
“Why did we not do our research earlier? I can’t believe it. In truth the cough started some time after the medication and was further complicated by fractured ribs and a haemothorax, which we had presumed had left lasting scarring of lung tissue. Many of the descriptions on your website are so accurate that it’s scary! The drug manufacturers must know how bad the cough can be!”
Julie’s story:
“I have an internet business and I am on the computer every single day. That means I spend a good bit of my spare time reading blogs, researching etc. NEVER in my 45 years…about 10 of which I have been online did I ever post or reply about a topic…UNTIL NOW!
“I have been on lisinopril for about 6 months. Everything was fine at first, until about a month in when I developed a very bad cough. I of course didn’t make a connection, as I had been on the medication for a while. I just assumed I had a simple cold, that is, until it continued and continued and the coughing spells became worse!
“I am simply miserable and so is my husband who sleeps with me! About 4 months in, I saw my regular doctor who happens to be a pulmonologist. She first treated me for bronchitis. Then she diagnosed me with allergies and later asthma.
“Wow, I thought… when did this all happen… mid 40s suck! I wholeheartedly believed my doctor until my close friend (who is a nurse) agreed with me that while I have had mild allergies for many years, they have never been severe! In addition, I had NO history at all of asthma.
“She then asked me if I was taking an ACE drug for blood pressure. She had experienced patients over her years as a nurse that complained of an ‘ACE cough.’ Because she is an amazing nurse and deeply cares about her patients she had researched the subject at one time. Well, well, well… my HORRIBLE COUGH AND SYMPTOMS exactly match the timeline from when I have been on the Lisinopril. Dry nagging constant cough, spitting up clear phlegm, unstoppable coughing spells that keep coming and coming, dry throat, no matter how much I drink etc, etc. It is literally the worst cough I have ever had and no cough medicine or steroid/rescue inhalers do a thing to help!”
“I have stopped taking this horrible medication and am BEYOND GRATEFUL to my smart girlfriend for figuring out what my doctor didn’t even suggest to me.”
Karl and his doctor:
“About 25 years ago, my internist prescribed Zestril (lisinopril) and I developed the characteristic dry, unproductive cough. I complained about it for two years and received no response.
“I owned some Merck stock and in the annual report it mentioned that the cough was an impediment to increased prescribing by physicians. I showed this to my internist and his response was ‘Oh, yeah, that happens.’
“Since I was in an HMO, I immediately transferred to another physician and registered a complaint. Of course, nothing ever came of that. I also changed to another medication and the problem was resolved within a couple of weeks.”
This cough is far more than a little tickle. It can keep people awake at night, cause them to vomit or even wet their pants and no cough medicine can calm it. The only solution is to switch to a different kind of blood pressure medicine.
In our eGuide to Blood Pressure Solutions we describe a variety of other medications to control hypertension along with many non drug options. We hope that doctors will begin to offer patients alternatives that do not cause the cough from hell.
Share your own experience with blood pressure medicines in the comment section below. Have you ever experienced the cough from hell? What about other side effects? Have you been able to control your blood pressure without medications? Let us know how you did it please. And if you think someone you know could benefit from this advisory, please share it via email or social media. Thank you for your support.
Lori
Please check into CANVAS (cerebellar ataxia, neuropathy, and vestibular areflexia syndrome). I finally got that diagnosis at age 65, and I’ve coughed for over 40 years and was told I have asthma.
LindaB
Thank you, thank you for this information. I too had developed a dry cough after starting Lisinopril 5MG. I have assumed I had developed acid reflux because the cough would lead to that much force. But a week ago I stopped taking it for different reason that my doctor and physician insisted was impossible. Water retention. Due to breast cancer surgery on both sides, plus colon, stomach and back surgeries, I have a very dysfunctional lymphatic system. Until I stopped this medication, I was having trouble urinating, while my legs and the tissue of my torso was so swollen that even my lymphatic drainage therapist couldn’t move it. As soon as I stopped Lisinopril the swelling went down. My cough is much better too.
Sharii
I am shocked at the coughing side effect from lisinopril’s being ignored by prescribers. I took it one day and quit. It almost threw me out of my chair, the cough was so severe. This was years ago; I thought it was listed under possible side effects and surely the prescribers (should) know it. On the other hand, why do patients put up with this?
Rita
I also suffered from a cough due to a very small dose of Lisinopril. It was not as bad as what many here describe, but it was relentless at night — started with a tickle, but then wouldn’t stop and kept me awake. I became quite depressed as well. It might have been the lack of sleep, but I wonder if the medication itself also had an effect.
I’m now on amlodipine with no coughing.
Elsa
Around 2008, 2009, a close friend developed a constant
dry cough. No meds or cough drops helped. His
Physician Assistant at the VA looked at his meds chart
and said “it’s the Lisinopril”. Better than the drs he
saw. Lisinopril works well to keep BP down, but the
side effects are bad for some. It took 3 different meds
to bring the BP down vs 1 Lisinopril, none of them
worked as well.
A neighbor had extremely high potassium, even
avoiding all foods that contained any. I had read in
PPh article that Lisinopril can cause a rise in
potassium. I showed her the article, she changed
to another BP med and saved her kidneys!
Thanks PPh!!
Pete
I wonder if anybody else has had problems with a bad cough after drinking hibiscus tea. I’ve been told it can work as an ACE inhibitor for blood pressure problems. I’ve been drinking a couple of cups of the tea a day and have a terrible cough that won’t go away. It causes me to cough the worst I’ve ever coughed. I didn’t drink tea any for a couple of months but still had a cough so I went back to drinking it, and the cough has gotten the worse it’s been now. Nothing seems to help it. I wonder if anybody else has dealt with this. I would love an answer if anybody has one.
Clif
While on lisinopril, I had a constant tickle and allergic reaction to eggs. I did not figure it out until I got a flu shot. I was super sick, a nurse was super alarmed. my HCP, an Internist was reluctant, but changed my meds. when I refused to take lisinopril. There were no precautions or warning about this reaction. I am lucky it wasn’t a lot worse.
Leon
While this is very important information, I think your listeners should also be aware that coughing like this can also be caused by chronic post-nasal drip. I think we’ve all experienced this at 1 time or another at the tail end of a common cold. My wife began waking at night with violent, hacking coughing exactly matching what you’re describing but she was not on any blood thinning medications.
I was very concerned that something serious might be causing it, or at least might be caused by it if left untreated. It was certainly affecting both our sleep and was necessitating her sleeping in another bedroom. She had extensive medical work up, including endoscopy, which all came up negative. I suggested postnasal drip and her MD started her on Xyzal, an antihistamine, 1 at bedtime. After a few nights, the coughing was markedly reduced. Subsequently, 1 of my dental patients mentioned similar symptoms that “no one can seem to figure out”. I suggested the same OTC medication and she had similar positive results. Just another thing to consider.
SharonD
I can’t remember when I started on Lisinopril but I was given this to monitor my kidneys since I have Diabetes 2 which I refused to admit until this year. Anyway I had the cough so bad that they thought I had asthma until a cardiologist friend told me that Lisinopril makes you cough. I then proceeded to tell my PC doc that I was not taking it any more and that she should find something that would do the same thing. She gave me an RX called Atacand (Candesartin) 4mg which I have been taking since 2016 or 2017 with no problems at all. You have to be the one to demand when you see your doc since I feel they do not always know the side effects. This is the same thing I do with my Diabetes meds. I research before I take anything. By the way I am 76 years old.
Lisa
Thanks to your previous articles on this topic, I knew about the “ACE cough”. When prescribed lisinopril, and I developed the cough a couple months later, I knew what it was. I my doctor that I had that side effect. He switched me to a different type of med, problem solved. Thanks so much for arming us with the knowledge to advocate for ourselves!
Kirk
As far as I know, every prescription that is dispensed has an accompanying leaflet (often on the outer bag with the price and other information) that gives common side effects, how to take the medication, etc. I believe Most states require it. People, PLEASE read the information accompanying your prescriptions. Most of these problems most likely could have been avoided, i’m pretty sure the 8nformation on ACE inhibitors mentions the chronic cough side effect. There’s no excuse for the extensive ignorance about the chronic cough side effect, especially among doctors. This isn’t a new thing, it’s knowledge that has existed for decades. I assume most people get their prescription and immediately toss the bag, receipt and information in the trash. It’s there for a reason.
TommyR
I was just diagnosed with Angioedema this morning. I’ve been taking 10mg of Lisinopril for the past 4 years. This morning I woke up with a VERY swollen bottom lip. Scary stuff. I was lucky it was only the lip.
Then I heard that Lisinopril can also cause a bad cough. For the past 4 years I’ve had a bad, unrelenting cough that no one seems to be able to figure out. Then I read about this. I am now on another non-ACE drug. I hope that is what caused the cough because it’s bad enough to make you think about ending it all. NO MORE ACE drugs.
Steven Shrewsbury
Glasgows cupboard
im a former student that goes to the “Official Glasgows Cupboard” hes touched me many times, i have lost many friends in this cupboard, never to be seen again.
I believe hes keeping them captive, and slaves, unless they been killed.
send police asap, thank you.
Jan
Florida
I stopped taking Lisinopril 4 weeks ago, and am still being plagued by the coughing fits, eyes watering, gagging/vomiting, nose blowing effects! How long will it take for these to stop?
Kathy
Northern Virginia
I had been dealing with a dry hacking cough for nearly nine months. I have been to the doctor at least six times concerning this cough. I was prescribed benzonatate (small yellow capsules), cough medicines, asthma inhalers, and allergy medicine all in an effort to deal with this cough. I am a narcoleptic who also takes a drug called Xyrem, which is a heavy duty drug to induce sleep (correct the sleep cycles). My sleep has been severely impacted by with this cough. I am now dealing with depression because of the lack of sleep from this drug from hell.
I have been off the drug for four days. The doctor told me it would take up to three weeks to see some improvement. I am so frustrated, my family is frustrated with me and what can you do but wait for it to subside. HERE I AM IN THE MIDDLE OF THE NIGHT WRITING THIS ENTRY HOPING SOMEONE WILL UNDERSTAND MY PAIN AND FRUSTRATION!
Harsha J
London
My husband started with viral infection and we went to see the doctor and they said nothing they can do….but after a week they found out it was infection. So he got some antibiotics but even that does not help. Can someone please advise how can we stop this coughing. It’s really bad and he can’t even breathe. Please advice……
Loretta
La
Doctor prescribed lisinopril. I just started To cough uncontrollably. Doctor ran all kind of test. Nothing showed up. Changed me to Valsartan, 160/25
Had a little cough, but tolerable.
Changed me to Valsartan 320/25
Coughing started again.
It appears, it’s not just ACE inhibitors, that cause cough.
Unsure what to do.
Pat
SC
OMG! I had the worst, violent, dry,coughing fits – sometimes inducing vomit (no nausea) for 4 months. Nothing seemed to help. Then my new GP noticed that my insurance changed from the Benicar (whichI had been taking for years with no side effects) to Lisinopril – about 4 months ago. He immediately changed the Rx to Losartan and within 48 hours my cough is GONE! I am furious that medical insurance coverage could and did cause so much needless suffering and who knows what other damage was caused by the Lisinopril!
Martha
Pennsylvania
I was put on a low dose lisinopril for high BP 5 months ago with little affect on my BP. Then I was put on Lisinopril HCTZ 2 months ago with great results on my blood pressure. My numbers were finally down where they should be but I had this annoying dry cough now and then.
But within a month the cough got so bad I was embarrassed to be around people because when the attacks hit there was no stopping the coughing until I gagged and sneezed and blew my nose over and over again. I couldn’t sleep at night and was so tired and irritable all the time. I was put on a cough medicine which would quiet the cough initially at night but then even the cough medicine didn’t work anymore.
I was on antibiotics for a possible sinus infection with no relief. I was living on cough drops, nose sprays, tylenol and bottles of water with no relief. So I stopped taking the Lisinopril/HCTZ. It has been almost 3 weeks now and I think the coughing spells are reduced but I read that it may take months until it is gone. I am prone to side affects from medications and will certainly now do my homework before starting anything new.
I’m hoping my doctor will now but me on an ARB drug instead of an ACE for my high blood pressure. I never, never want to deal with a cough like I have these last few months. It is truly ‘the cough from hell’. There is no normal functioning with it. I am living for the day the cough is gone!!!!
Reka
Australia
I have this kind of cough for 8 years and never took any medication. What else can cause it then? Please help:(!
Elaine
Elma, NY
I took Lisinopril for a few to several years. I started having difficulty swallowing pills of any kind and felt like my wind pipe was being cut off… just before I passed out. I wound up in the hospital 3 times over a period of three years. The last time the Doctors wanted to put a pace maker in but I kept telling them it wasn’t my heart, it was my throat. They, at my insistence, did a sonogram and said I had a goiter. Nobody ever mentioned Lisinopril but I was taken off of it and have improved greatly. I also have had (and still do have) a “cough from hell”. It’s been about 8 months since I’ve been off Lisinopril and have been told by a Medical friend of mine that I should never take another pill ending in “pril”. I still have some difficulty swallowing but hopefully I will continue to improve.
Elaine
John
90290
I take lisinopril, and although I don’t have a cough as bothersome as some, I have a very dry mouth at night…I take the lisinopril just before bedtime. I’m now wondering if the dry mouth comes from that. I didn’t have it when I was taking a different “pril”.
Barbara
McKinney TX
After open heart surgery and five bypass grafts, my surgeon put me on Ramipril in the hospital. I coughed and coughed and was afraid I was going to develop pneumonia and kept requesting breathing treatments. When I was discharged, I continued coughing and couldn’t sleep night after night. Then, during another sleepless night, at about three in the morning, I read your column in the newspaper and the answer to my cough was right in front of me. I called my surgeon in the morning and asked to be taken off that drug. I was never warned about this side effect and suffered terribly. I will be forever grateful to the People’s Pharmacy.
cna
so. calif.
I am not familiar with ace inhibitors but I get this cough after having a basic cold that turns into a cough. It can last 6 to 8 weeks and there is no relief. Is there any other condition that can cause this cough and any ideas on how to relieve it? I used to cough and it did not cause gagging and retching but the last year, every time I get the “coughing cold” I end up with this horrible, uncontrollable cough. What are the best ways and medicines to relieve this? anyone?
Nancy
North Carolina
Did you find any relief for your cough? The doctors say that I “just have bad allergies” but this is ridiculous to cough like this. I take allergy shots and have tried multiple allergy medications.
Last week, I started taking some homeopathic remedies to see if these will help. The Vick’s Vapor Rub did not help me. Any ideas and info for a chronic chough would be appreciated.
Karen
Ca.
I have been on Atenolol for 5 months and my asthma returned with a horrible cough which kept me up most of the night. I had no idea until I did my own research on this DRUG that it would cause this reaction. I had told my doctor I had asthma as a child but he still put me on this crap. Now i am slowly weaning myself off of it so I can feel normal again. Bottom line we have to be our own advocates when it comes to prescriptions that doctors blindly give us.
This really is maddening and I will try a more natural way to get my blood pressure down. Take care! Karen
Fred
Austell Ga
The Lisinopril cough from Hell did kill me. A two week cough 24/7 sent me to my doctor and while in his waiting room, I suffered cardiac arrest and died. The doctor did CPR on me (first time in 30 years) and staff used an AED to shock me and praise the Lord it worked on the third try. I now have an implanted defibrillator in my chest.
Virginia
Any other drug that could cause this miserable coughing? Clean diagnostic tests.
Ruth
Ohio
This is about drug side effects, but not coughing. I am talking about hair loss and beta blockers.
I had been put on a beta-blocking eyedrop for severe glaucoma, Cosopt PF, preservative-free because I am allergic to the preservative. It contains timolol maleate, a beta blocker After a couple of weeks, my hair began falling out–brushfuls with every stroke. My hairdresser said that blood-pressure drugs (i.e., the beta blocker, though this one was in eyedrop form) are ‘famous for causing hair loss.’ She recommended a shampoo, which did nothing . I found an Internet discussion board with 100 or so comments about women on beta blockers losing their hair, their doctors in most cases not knowing what to do. Two commentors had a solution: Vitamin B12. I started taking one tablet a day, and within a week, my hair had stopped coming out. This was news to my eye doctor too. Maybe it will help someone else out there.
Mary
SC
Several years ago I developed a small hacking cough which was very annoying. I should have bought some stock in a cough drop company because I took so many. I went to my primary care doctor, and she gave me a breathing test. It was fine. Finally she sent me for allergy tests–all negative. The allergists asked if I was on any blood pressure meds, and yes, I was on Lisinopril. He said that sometimes causes coughs, and I should come off them and contact my personal care doctor. I did what he advised. Within a week my cough stopped. I was put on Verapamil instead and have no problems.
rosemary
Midwest
No doctor told me about the Lisinopril cough. I read up on all the meds I take for heart (I have 5 stents, one in each carotid and three in my heart, genetic heart disease) When I had such awful coughing issues at work, I had to stop working and sit down (line work in a factory–I’m the working poor). I looked up that symptom on the internet. It took two years before it subsided but people sure used to look at me funny when I told them it was the heart meds that did it. They thought I was sick with something else, catchable, I think :-)
I DID absolutely REFUSE to take the statins that they give everyone with heart issues. They caused bloody diarrhea so bad that I was in bed for two days. The doctor said, “Oh, you have to take this,” and I said “NO, I don’t. NO medicine should make anyone THAT ill.”
I changed doctors, and I bet he was glad. You PAY doctors to make you better. Don’t put up with doing whatever they say if it is not helping. They are your hired man and should work for you.
Mona
Florida
My Dr. started me on lisinopril. . At about that time I experienced eye problems. I really could not describe what was wrong, but they bothered me. I finally went to eye doctor. He checked my eye, told me the pressure was good and all was well.
When I got home I was setting up my mothers medications and she also was on lisinopril so I read the side effects sheet and near the very end was SWOLLEN eyelids! I stopped taking the lisinopril and of course my problem disappeared.
Paul
New Hampshire
This is an example of why patients should ask to be counseled on their medicines and not sign the release form. Any pharmacist would cover the cough in the ACE inhibitor side effect section. Over the years I found several patients who had coughs and didn’t know that it was being caused by the ACE inhibitor.
Also, its up to patients to educate themselves to protect themselves. Every Rx has a document that covers side effects and the ACE inhibitor Rx is no exception.