Every Monday afternoon I see patients in a small town clinic. Last week it was time to see Elsie, one of my favorites for her monthly check of her blood thinner medicine. She had raised 12 children, was 83 years old and a widow. Ron, one of her 6 sons had driven her to her appointment because he was concerned about her. Every time I see Elsie, I ask her the same questions. Today was no different.
“Any new medicines since I saw you last?” I asked, as I glanced at my laptop with her chart on the screen.
“Why, yes. I saw the heart doctor and he increased one of my medicines. Ron knows which one it is…” as she looked across at her son sitting in the chair to my left in our exam room.
“When was that?” I asked.
“Oh, about 2 weeks ago, now,“ replied Elsie.
“Okay, then. Is it the one that starts with an L? That’s the only other heart medicine I see here on your list of medicines. It shows here that you’ve been taking one tablet of 5mg lisinopril twice a day.”
Ron nodded, and when I asked if he knew what her dose was changed to, he handed me a folded paper that read: “Increase lisinopril 5mg to two tablets twice daily”. He then looked across the room at his mother. “Ask her what you can take for allergies.”
“Dr. Louise, can you recommend something for allergies? I’ve tried the usual stuff but nothing seems to help.”
“What kind of allergy symptoms are you having, Elsie?”
“Just a cough.”
“Are you coughing anything up?”
“Well, no. Just a dry tickle.”
“That cough keeps you up at night, Mom.”
“Well, it may not be allergies after all, Elsie. I’m really glad you said something about it.”
I sent a message to her family doctor about her new cough symptoms since the medication adjustment and it was addressed the very next day with a medication change.
A couple of hours later, I was talking with radio personality Dottie Kaufman. She told me how she had spent 3 months and over $200 seeing an allergy specialist for a dry cough that had caused big problems for her on her radio show. The specialist couldn’t help her, so she continued to put up with it. One day, she was talking to a pharmacist who connected her cough symptoms with a prescription medicine she had started right before the cough showed up. The name of the medicine was lisinopril. Within days of stopping her lisinopril, Dottie’s cough vanished and has never returned.
My father was diagnosed with diabetes at age 78, and his family doctor started him on 3 pills: one for his blood sugar, one for his cholesterol, and one to protect his kidneys. A couple of weeks later while we were talking on the phone, he asked me about them. The medicine he was taking for his kidneys was lisinopril. I asked, “Dad, have you noticed any coughing?”
“No. I feel just fine.” “That’s great, Dad! Be sure to mention it to your doctor if you notice any nagging, tickly type of cough, ok?”
Nine months later my dad had his left knee replaced and I came to stay overnight with him after his surgery so he wouldn’t have to go to a nursing facility. But he wasn’t taking lisinopril any more. Instead, he was on losartan, which is what doctors usually switch to if the lisinopril causes any side effects.
Dad did fine at his starting dose of lisinopril, but, just like Elsie, he developed a nagging cough when his doctor increased the dose. He was changed to the losartan and hasn’t had any further problems.
Lisinopril belongs to a group of drugs called ACE Inhibitors, which are all related to each other and have the word fragment –pril in their generic name, like ramapril and lisinopril. One of the most commonly prescribed drugs in America, lisinopril is given to lower blood pressure, strengthen the heart in congestive heart failure, and to reduce the potential for kidney problems in diabetes. However, it is also notorious for causing a chronic dry cough. One out of every 4 people started on an ACE Inhibitor will develop a cough similar to those described by Elsie and Dottie.
If you have just started a new medicine, speak up if you notice any unusual symptoms. There are lots more strategies for taking your medicine safely in my book, Why Dogs Can’t Eat Chocolate: How Medicine Works and How YOU Can Take it Safely.
