After excluding patients with cough accompanied by the features of acute infection fever, rhinitis, myalgia from the analysis, the incidence of cough decreased to 6. Of the study participants, 7. The cough did not appear after initiation of ramipril therapy until the baseline visit in 4. At the baseline visit, patients remained on ramipril therapy despite the occurrence of cough. A total of 10, A total of 9, Discontinuation of ramipril was reported secondary to ADRs in After therapy cessation, the cough resolved in The median time of cough subsiding after discontinuation of ramipril treatment was 5 interquartile range 4—11 days range from 2 to 20 days.
ADRs, excluding cough, were reported in 1. Ramipril-related cough not associated with infection, excluding cases with persistent cough 8 weeks after cessation of therapy, was observed in participants 7.
Incidence of ramipril-related and non ramipril-related cough related to time to occurence. Therapy with ramipril was discontinued in of patients with cough.
The symptom subsided in of them In all patients reporting the appearance of cough within the first 5 days after therapy initiation, the cough symptoms resolved after therapy was discontinued. If the cough appeared within 6—10 days, it subsided after discontinuation in Ramipril-related cough occurred significantly more in patients with chronic diseases conducive to the occurrence of chronic cough — chronic obstructive pulmonary disease, asthma, allergic rhinitis, chronic sinusitis, history of tuberculosis, mitral valve disorder or thoracic aortic aneurysm In univariate age-adjusted logistic regression, ramipril-related cough occurred significantly more frequently in patients with hypertension, peptic ulcer disease, asthma, COPD, prior history of tuberculosis, and smokers.
Ramipril-related cough occurred less frequently among those suffering from gastro-esophageal-reflux disease GERD and chronic rhinosinusitis Table 3. Factors influencing ramipril-related cough age-adjusted univariate logistic regression. GERD and chronic rhinosinusitis were the only 2 factors demonstrating a decreased risk of cough in this model.
For any variable included in the regression model, the VIF did not exceed the value of 1. Maximal value of the conditional index was 3. Based on these results, we may expect that our logistic regression model is free from multicollinearity. This study shows that ramipril-related cough occurred in 7. Factors such as female sex, cigarette smoking, chronic obstructive pulmonary disease, asthma and previous history of tuberculosis seem to contribute to an increase in its occurrence.
A baseline history of these factors may therefore be helpful in identification of patients particularly at risk of its occurrence. Careful attention to patients with these risk factors may prevent misdiagnosis and improper treatment of this well-known adverse-effect. Perhaps in these patients it would be reasonable to substitute ACE-I for an angiotensin II antagonist, bearing in mind that ACE-I-induced cough is a class-wide adverse effect and may occur with other agents in this class.
There is also a times increased risk for potentially fatal angioedema in patients with a history of ACE-I-related cough [ 31 ]. During an 8-week observational period, the incidence of dry cough was reported in 3. It is possible that not all incidences of cough were reported by the team of researchers.
However, much higher rates were reported in a study conducted in India, where a rate of During a period of 14 weeks in the Canadian study and at the end of an 8-week period in the Hathiala study, the incidence of cough was reported as The observed discrepancies may be partially explained by various racial differences, co-morbidities, and pharmacotherapies.
The CARE study determined that cough appeared most frequently among Caucasian patients, constituting This racial differentiation may not explain the markedly greater incidence of cough in the Polish population reported in this study, compared to the Americans in the CARE study.
These results confirm results of another published study supporting the hypothesis that women are more susceptible to developing ACE-I-induced cough [ 21 ]. Co-morbid conditions are also factors that may influence variation in reported incidence of cough.
In this study, we did not exclude patients with illnesses pre-disposing patients to chronic cough, which was In these patients, the incidence of ramipril-related cough was One study identified a group of patients with asthma who exhibited cough during treatment with ACE-I, and found that the sensitivity of cough reflex increased during the treatment [ 16 ]. As shown, ACE-I sensitizes the cough reflex.
Such an association was not found by Singh et al. We found that rhinosinusitis was not among the illnesses that independently increased the risk of ACErelated cough, probable as this etiology is frequently associated with asthma [ 35 ]. The absence of chronic rhinosinusitis among the independent factors demonstrating an increased risk of ramipril-related cough in our study may suggest that only a subset of patients with eosinophilic airway inflammation have an increased risk of ramipril-related cough.
During ACE-I treatment, cough occurs most frequently in the early period of therapy. The Hathial study reported an even earlier appearance of this adverse drug reaction. According to this research, during the first week of treatment coughing occurred in 7. The causal relationship between ACE-I and cough also indicates a reduced resolution if the symptom onset appeared in the later period of observation.
According to our findings, after discontinuation of ramipril treatment, cough resolved in The incidence of cough can also be affected by the use of other drugs. In this study, data on the concomitant treatment of cardiovascular and respiratory diseases were not collected. Thus the analysis of the impact of polypharmacotherapy on the incidence of cough cannot be performed and it is among the main limitations of this analysis.
In this study patients that experienced cough and did not attend the second follow-up visit were assumed to have ramipril-related cough. This may possibly have led to overestimation of the percentage of ramipril-related cough. On the other hand, the first follow-up visit was planned for after 4—8 weeks, while ACE-I-related cough sometimes starts after several weeks or months. This method therefore might lead to some underestimation of the percentage of ramipril-related cough.
Side effects often improve as your body gets used to the medicine. Common side effects These common side effects happen in more than 1 in people. Talk to your doctor or pharmacist if these side effects bother you or do not go away: a dry, tickly cough that does not go away feeling dizzy or lightheaded, especially when you stand up or sit up quickly this is more likely to happen when you start taking ramipril or move on to a higher dose headaches diarrhoea and being sick vomiting a mild skin rash blurred vision Serious side effects It happens rarely, but some people have serious side effects after taking ramipril.
Call a doctor straight away if you get: yellow skin or the whites of your eyes turn yellow — this can be a sign of liver problems paleness, feeling tired, faint or dizzy, any sign of bleeding like bleeding from the gums and bruising more easily , sore throat, a high temperature and getting infections more easily — these can be signs of a blood or bone marrow disorder a faster heart rate, chest pain and tightness in your chest — these can be signs of heart problems shortness of breath, wheezing and tightening of the chest — these can be signs of lung problems severe stomach pain — this can be a sign of an inflamed pancreas swollen ankles, blood in your pee or not peeing at all — these can be signs of kidney problems weak arms and legs or problems speaking — these can be signs of a stroke If you suspect that you or someone else is having a stroke, phone and ask for an ambulance.
Serious allergic reaction In rare cases, ramipril may cause a serious allergic reaction anaphylaxis. Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information. What to do about: a dry irritating cough — cough medicines do not usually help for coughs caused by ramipril. Sometimes the cough gets better on its own. Talk to your doctor if it carries on, bothers you or stops you sleeping, as another medicine may be better.
Even if you stop taking ramipril, the cough may take a few days to a month to go away. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if they last longer than a week or are severe. If you're being sick, take small, frequent sips of fluid. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee.
Do not take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor. If you get diarrhoea or vomiting from a stomach bug or illness, tell your doctor. You may need to temporarily stop taking ramipril until you feel better. Check with the pharmacist to see what type is suitable for you. If it lasts for more than a day or two, speak to your doctor as they may need to change your treatment.
Ramipril is not normally recommended in pregnancy or when breastfeeding. Ramipril and breastfeeding Small amounts of ramipril may get into breast milk. Non-urgent advice: Tell your doctor if you're:. There are some medicines that may affect the way ramipril works.
Important: Medicine safety Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. How does ramipril work? How long does ramipril take to work? In these cases, you may not feel any different when you take ramipril.
How long will I take it for? Is ramipril safe to take for a long time? What will happen if I stop taking it? Talk to your doctor if you want to stop taking ramipril. Can I come off ramipril now my blood pressure is lower? Can I drink alcohol with it? Are there similar medicines to ramipril? There are also lots of other types of blood pressure-lowering medicines: calcium channel blockers like amlodipine angiotensin receptor blockers like candesartan beta blockers like bisoprolol diuretics like bendroflumethiazide If you cannot't take ramipril or other ACE inhibitor medicines because of side effects such as a dry cough, you may be able to switch to another type of blood pressure-lowering medicine.
What are the differences between ramipril and other ACE inhibitors? The side effects are also similar to those of other ACE inhibitors. There are a few differences between ramipril and other ACE inhibitors. Can I take ramipril before surgery? Your doctor may advise you to stop taking it 24 hours before surgery. Is ramipril addictive? No, there's no evidence that ramipril is addictive.
Will it affect my contraception? Ramipril will not affect any type of contraception. Will it affect my fertility? This medicine is usually not recommended in pregnancy. Share with twitter. Share with linkedin. Share using email. Getty Images Can't stop coughing? ACE inhibitors may be to blame. More answers from Ask the Pharmacist. Also of Interest Join AARP today and receive access to exclusive information, benefits and discounts More health information you can use Visit the AARP home page every day for great deals and for tips on keeping healthy and sharp.
Leaving AARP. Got it! Please don't show me this again for 90 days. Cancel Continue. Thank You. Your email address is now confirmed. Continue to AARP. Offer Details. Thank you for your interest in volunteering! Physicians should be aware that a dry cough is the most common adverse effect of ACE inhibitors and that this symptom may occur not necessarily shortly after institution of therapy but months or even a year later. Replacement by another ACE inhibitor should not be tried, since the cough will almost always recur on rechallenge with the same or another ACE inhibitor.
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