If a patient has a cough on ACE inhibitors, which medication class should be used instead?

If a patient has a cough on ACE inhibitors, which medication class should be used instead?

• A. Beta-blocker
• B. Calcium channel blocker
• C. ARB
• D. Diuretic

Answer: (C)

ACE inhibitors can cause a dry cough because they increase bradykinin levels in the airways. When this troublesome side effect occurs, the best substitute is an ARB. Angiotensin receptor blockers block the same final pathway as ACE inhibitors—angiotensin II’s effects on the AT1 receptor—but they do not raise bradykinin, so the cough is typically not reproduced. Switching to an ARB provides similar blood pressure control without triggering the cough. Examples include losartan, valsartan, candesartan, and irbesartan. Other drug classes like beta-blockers, calcium channel blockers, or diuretics don’t specifically address the cough caused by bradykinin buildup and are not the preferred replacement for this side effect.

ACE inhibitors can cause a dry cough because they increase bradykinin levels in the airways. When this troublesome side effect occurs, the best substitute is an ARB. Angiotensin receptor blockers block the same final pathway as ACE inhibitors—angiotensin II’s effects on the AT1 receptor—but they do not raise bradykinin, so the cough is typically not reproduced. Switching to an ARB provides similar blood pressure control without triggering the cough. Examples include losartan, valsartan, candesartan, and irbesartan. Other drug classes like beta-blockers, calcium channel blockers, or diuretics don’t specifically address the cough caused by bradykinin buildup and are not the preferred replacement for this side effect.