Doctors often prescribe Inhibitors of angiotensin-converting enzyme (ACE inhibitors; eg, captopril, ramipril, and enalapril) for treatment of high blood pressure, heart failure, and diabetes-related kidney disease. It has been seen that about 10% of these individuals develop a persistent dry cough, whatever dose receive, and the cough is relieved only by withdrawal of the treatment. Though cough is not harmful in itself, but it is so annoying for some patients that they stop taking medicine at all, that may lead to complications of hypertension.

What to do to stop ACE induced Cough

There is not much data in this regard. You may stop ACE inhibitors and switch to another group of medication called as ARBs after consultation with your doctor. They are however, some certain situations where ACE inhibitors are the only best choice. For those cases, Dr. Pier Luigi Malini and colleagues from the S Orsola Hospital in Bologna, Italy, report that picotamide (currently being researched and not available in the US yet) is a medicine that may relate ACE induced cough when used together with ACE inhibitors.The basic mechanism of this medicine is that it acts to prevent aggregation of platelets (an early step in the formation of blood clots).

In that study, picotamide was given to nine patients with ACE-inhibitor-induced cough, out of those nine, eight patients declared that cough was completely stopped after few days of starting Picotamide. The investigators performed this study by giving a placebo (inactive substance) for two weeks and picotamide for another two weeks and the patients did not know which was the real drug, but the responses to picotamide were remarkable. They noticed that unresponsive patient did not absorb picotamide properly. One thing was very attractive, that picotamide did not show any kind of interaction with effects of ACE inhibitors.

Majority of doctors adopt another approach of switching to another type of treatment like ARBs. However, for patients who have to continue to take ACE inhibitors, picotamide may be the drug of choice. I have noticed in my patients that even ARBs cause dry cough in some patients when use in high doses.

A Korean study reveals that Iron Supplementation Inhibits Cough Associated With ACE Inhibitors. Dry cough induced by ACE inhibitors is thought to be associated with the increase in nitric oxide (NO) generation. Bronchial epithelial cells have an inflammatory effect due to nitric oxide (NO). This study was carried out by Dr. Hong and colleagues. They embarked on their study, based on reports that iron supplementation decrements NO generation or diminishes NO-related bronchial cell damage. According to this small study's findings, Iron supplementation appears to treat ACE-inhibitor-induced cough effectively in the short term. Iron is very attractive treatment option for many patients due to its safety and less cost. As with any treatment, recommendations should be tailor to individual patients. Before taking any kind of medicine please consult with your doctor.