9 Medications That Cause Coughing: Here’s What to Know About a Drug-Induced Cough

We’ve all experienced a cough at some point. Typical culprits are the common cold, respiratory conditions like asthma, or seasonal allergies. 

But certain medications can cause or contribute to a drug-induced cough. From blood pressure medications to steroid nasal sprays, cough is a reported side effect of several treatments.

Your healthcare professional (HCP) can help you figure out which medication could be behind your cough. Here’s a guide to nine medications that can cause cough and tips for managing your symptoms.

1. ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are first-choice medications for managing hypertension (high blood pressure). But a dry cough is actually one of their most common side effects. A persistent, dry cough has been reported in up to 35% of people taking ACE inhibitors.

Examples of ACE inhibitors include:

• Lisinopril (Zestril, Qbrelis)

• Benazepril (Lotensin)

• Enalapril (Vasotec, Epaned)

• Ramipril (Altace)

• Captopril

• Perindopril

Thankfully, an ACE inhibitor-induced cough isn’t medically serious. But it’s often quite bothersome. A drug-induced cough can happen right after starting an ACE inhibitor or even after taking it for a while. 

Researchers believe ACE inhibitors cause two proteins, bradykinin and substance P, to build up in the airways. In turn, this leads to airway tightening and coughing. But some research suggests that perindopril may be less likely to cause a cough than other ACE inhibitors.

Good to know: If you experience a cough while taking an ACE inhibitor, your HCP may switch you to a different medication — such as an angiotensin II receptor blocker (ARB). Losartan (Cozaar) and valsartan (Diovan) are common ARBs, and they don’t usually cause a cough.   

2. Certain beta blockers

If you have a heart-related condition, your HCP may prescribe a beta blocker to manage symptoms. These medications lower heart rate and blood pressure by blocking beta receptors (chemical binding sites) inside the heart and blood vessels. But certain beta blockers may trigger a drug-induced cough if you also have asthma.

“Nonselective” beta blockers also target beta receptors throughout your entire body, including the lungs. This may trigger an asthma attack with symptoms such as coughing and wheezing. Here are some examples of nonselective beta blockers:

• Carvedilol (Coreg)

• Propranolol (Inderal LA, Innopran XL)

• Labetalol

• Nadolol

If you have asthma, your HCP may proactively recommend a “selective” beta blocker, such as atenolol (Tenormin) or metoprolol (Lopressor). These act on the heart and blood vessels without affecting the lungs to the same degree.

3. Calcium channel blockers

Calcium channel blockers (CCBs) treat heart conditions such as hypertension and coronary artery disease. While uncommon, CCBs may indirectly cause a drug-induced cough in some people. Common CCBs include:

• Amlodipine (Norvasc)

• Nifedipine (Procardia, Procardia XL)

• Nicardipine

• Verapamil

• Diltiazem (Cardizem)

CCBs relax muscles in the esophagus, which can cause stomach acid to come up more easily. For people who already have gastroesophageal reflux disease (GERD), this can potentially make symptoms worse. Cough is one of the possible symptoms of GERD.

4. Statins

Statins are popular medications that treat high cholesterol. Popular examples are atorvastatin (Lipitor), simvastatin (Zocor), and pravastatin. You’ve likely heard of certain statin side effects such as muscle pain. But they can also cause a drug-induced cough.

The reason why statins cause coughing isn’t clear. It may be because statins can cause your body to make more of a substance called prostacyclin. This might lead to coughing. Statins can also amplify the production of a chemical called nitric oxide. This could also make you more prone to coughing.

If you develop an annoying cough that won’t go away, talk to your prescriber. They may consider a slight adjustment to your medication routine.

Good to know: You may be more likely to develop a cough if you’re taking a statin and ACE inhibitor together. As mentioned, ACE inhibitors can cause a drug-induced cough on their own. But research shows that statins can also impact bradykinin levels.

5. Nitrates

Nitrates treat chest pain by relaxing blood vessels. Nitroglycerin (Nitrostat, NitroMist, others), isosorbide mononitrate (Monoket), and isosorbide dinitrate (Isordil) are a few examples.

Nitrates work in part by releasing nitric oxide, which plays a key role in how these medications do their job. But raising nitric oxide levels may relax muscles in your esophagus. Like CCBs, nitrates may worsen GERD symptoms such as coughing. But this tends to be rare.

6. Methotrexate

Methotrexate treats many health conditions, such as cancer and rheumatoid arthritis. But it also has a variety of side effects, including potential lung problems. 

While lung damage is rare, a dry cough is one of the warning signs. Lung problems have occasionally been reported within the first year of starting methotrexate.

If you experience shortness of breath, fever, or cough, reach out to your HCP right away. They will likely stop or pause your methotrexate prescription and treat your lung inflammation.

7. Fentanyl

Opioids treat moderate-to-severe pain. While they can be effective for managing your symptoms, they do come with side effects. A drug-induced cough has been reported in many people taking fentanyl.

There are unique theories as to why fentanyl causes coughing. Fentanyl may trigger the release of the chemical histamine, which can cause coughing. Certain receptors can also become activated and cause the airways to tighten.

8. Certain glaucoma medications

If you’re living with glaucoma, your HCP may prescribe eye drops to lower your eye pressure. In most cases, side effects are limited to the eye area. But sometimes, eye drops can absorb into your body or leak into your throat.

Timolol is a nonselective beta blocker eye drop that may trigger a cough if you have asthma. Latanoprost (Xalatan) is a prostaglandin eye drop that can cause a drug-induced cough, too. Research suggests that raising the amount of prostaglandins with medications such as latanoprost may trigger coughing.

Your pharmacist can provide tips on how to administer your eye drops to get the most out of your medication and minimize side effects. It’s best to press your finger on the corner of your eyelid, closest to your nose, after administering your medication. This can help prevent your eye drops from leaking into your throat, nose, and the rest of your body.

9. Steroid nasal sprays

If you have allergies, you may have an over-the-counter (OTC) steroid nasal spray on hand to manage your symptoms. Fluticasone (Flonase) and triamcinolone (Nasacort) are two examples of popular OTC steroid nasal sprays. These medications are typically well tolerated. But they may trigger a sore throat and drug-induced cough.

It’s best to avoid tilting your head back when you use a steroid nasal spray. Instead, tilt your head forward a little bit. This will prevent the medication from dripping down your throat. Gargling with water after using a nasal spray may also lower the chances of experiencing throat irritation and cough.

How to treat a drug-induced cough

It’s natural to feel frustrated if you experience a drug-induced cough — especially if it’s affecting your daily routine.

It’s possible to manage your cough at home. Menthol cough drops, honey, and a humidifier can all offer some soothing relief. OTC cough medications can help temporarily, too. If needed — and with your HCP’s permission — you can also try briefly stopping a medication if you think it’s causing your cough.

These steps won’t always be enough. If your cough doesn’t improve within 1 to 2 weeks, contact your HCP. They can offer more personalized management tips.

Should I be worried if my medication causes chronic coughing?

In most cases, no. But if you’re experiencing more serious symptoms at the same time, such as trouble breathing, chest pain, or fever, contact your HCP without delay. These could be symptoms of a more urgent issue.

Keeping a current medication list handy is helpful, too. Your HCP can check to see if any of your OTC or prescription medications are contributing to your cough.

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Written by:

Jennifer Gershman, PharmD, CPh, PACS

Jennifer Gershman, PharmD, is a licensed pharmacist in Florida. She has worked in the pharmacy industry for more than 15 years and is currently a medical writer.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Tegan Smedley, PharmD, APh

Tegan Smedley, PharmD, APh, has 10 years of experience as a pharmacist. She has worked in a variety of settings, including retail, hospital, and ambulatory care.

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