ACE Inhibitor-Induced Cough Management

Clinical Characteristics

The American College of Chest Physicians notes that ACE inhibitor-induced cough presents as a dry, nonproductive cough with a tickling or scratching sensation in the throat, which is not dose-dependent and can occur at any time after initiation of therapy, more commonly in women, nonsmokers, and persons of Chinese origin 1, 2
The cough onset can range from hours after the first dose to weeks or months after initiation, and is not immediately life-threatening 1, 3

The American College of Chest Physicians provides a Grade B recommendation to discontinue ACE inhibitor therapy immediately, as this is the only uniformly effective treatment, with cough typically resolving within 1-4 weeks after cessation 1, 2
The ACC/AHA guidelines give a Class I, Level A recommendation for switching to an Angiotensin Receptor Blocker (ARB) such as valsartan or losartan, which has a significantly lower incidence of cough compared to ACE inhibitors 4
Allow at least 36 hours between the last ACE inhibitor dose and starting the ARB, and monitor blood pressure, renal function, and potassium within 1-2 weeks after the switch 4

The American Heart Association and American College of Cardiology recommend that patients with underlying conditions be closely monitored when switching from ACE inhibitors to ARBs, with consideration of individual patient risk factors 4