Some adverse drug reactions are subtle and easy to overlook. For example, doctors could be forgiven for not catching a vitamin B12 deficiency associated with long-term prescriptions of popular acid-suppressing drugs like esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec). This complication was not taught in medical school and requires some digging to figure out.
Symptoms of vitamin B12 deficiency are also subtle. They sneak up on people over months or years and can include memory problems, confusion, numbness, tingling or pain in toes, feet or fingers, difficulty walking or burning tongue. A standard serum B12 test may not reveal the problem. A doctor might also need to order a test of methylmalonic acid (MMA).
The point is, doctors can be excused if they don’t immediately recognize drug side effects like vitamin B12 deficiency. It’s just not that obvious.
ACE Inhibitor Cough is NOT Forgivable!
On the other hand, there are some drug side effects are so recognizable that they should never be overlooked! One symptom in particular is called an ACE (angiotensin converting enzyme) inhibitor cough. Keep in mind that this class of blood pressure medications is one of the most commonly prescribed medications for hypertension. Tens of millions of prescriptions are written for drugs like captopril (Capoten), benazepril (Lotensin), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace) and trandolapril (Mavik).
Every medical student in the world is taught that an uncontrollable cough is a common side effect of this category of high blood pressure medicines. Depending upon the study, a disruptive cough occurs in anywhere from 5 to 35 percent of patients who take an ACE inhibitor. That means every patient who gets a prescription for one of these medications should be warned of this potential side effect and if it occurs should be switched to another drug.
What’s the Big Deal About a Cough?
You might be wondering why we would be making such a big deal about such a seemingly simple problem. First, this cough is NOT simple. It can disrupt your life. It cannot be controlled with cough medicine. This is the kind of cough that can keep you awake at night or make you pee in your pants. It can have a devastating effect upon your quality of life as you will shortly read in real-life stories from patients.
What really drives us wild is that far too many doctors seemingly do not recognize that this cough can be caused by the blood pressure medicine they have prescribed. Patients get sent to allergists, pulmonologists and other specialists to be worked up for all manner of other ailments. The cost of this unnecessary testing is outrageous, especially when the solution is as simple as changing the medicine.
Here are just a handful of the many stories we have received on this issue:
Emma relates an amazing tale of desperation:
“I am so disgusted by the side effect of severe coughing, for six months now, not to mention also throwing up at least a dozen times. I have been to my doctor several times for this cough.
“First I was given Benzonatate (a cough suppressant). No improvement.
“I went back to the doctor a few weeks later and was given a shot of steroid. No improvement.
“I went back a few weeks later and was given a chest X-ray. All clear, but no change in the cough. I was given hydrocodone cough medicine [a narcotic] which I took at night in an attempt to get some rest. I am surprised my husband still sleeps in the same room with me. I wake him up all night randomly having coughing attacks.
“I am a Realtor and this has caused my business to come to a halt. I can’t talk for 5 minutes without having hacking attacks. My dear mother even suggested I get tested for TB.
“I’ve lost my voice, I can’t even stand to sing alone. My voice now sounds like some heavy smoker (I am not a smoker and never even get around second hand smoke).
“This all came on real fast after starting lisinopril for high blood pressure. It has cost me time, money, joy and basically I stay more to myself.
“I work out several times a week at a gym, but now try to go on off hours so as not to scare people. How long can you tell family, friends, and even strangers not to worry, that your cough is not contagious? This is awful.
“Thankfully the nurse noticed the fact I kept coming back because the cough was not going away. She asked if I happened to be on lisinopril and then suggested to my doctor that he change my prescription. Okay, well, it’s been several months now, and it has not let up.”
Donna shares a similar story:
“Lisinopril…it’s a nightmare. I had the flu three months ago and around the same time had to start blood pressure meds. One week into my flu I developed a horrible cough. Well I just thought it was the flu. Another week passed. I developed laryngitis from the cough.
“It’s been three months of coughing now. I have had two ER visits and three doctor visits. Today at 4:30 am, when I finally said I can’t sleep anymore, I made another trip to the ER.
“The doctor put me on yet another round of steroids and another antibiotic. I finally asked, “could this be my blood pressure meds doing this to me?” He said, “better talk to your doctor because it may be.”
“I called her and said, “How many ER visits, how many doctor visits, how many meds did I have to go through? I had to figure out it’s my blood pressure pills on my own!”
“Now that my family hates me for the months of annoying coughing and I can barely work because I’m in retail and have to talk. They want to put me on another ACE inhibitor! I flat out refused to take one. I have been miserable. I hope my Dr can find another solution because I’m done with doctor visits and pills.”
This from Lyn:
“I was prescribed ramipril about 8 months ago for high blood pressure. Since then I have had a terrible debilitating cough that kept me and everyone else awake most of the night. I have terrible bouts of coughing at work where it is impossible for me to go to meetings as I cough so violently that I gag and throw up.
“I even threw up while driving as I did not have time to pull over before throwing up. I am too embarrassed to go to the hair dressers, dentist or out for a meal due to the terrible bouts of coughing.
“I have been back to the doctors twice and been prescribed a nasal spray and montelukast asthma tablets. They did not work.
“I stopped taking the ramipril 2 days ago and the cough is subsiding quite rapidly. I no longer vomit or gag or cough as violently or anywhere near as frequently.”
The stories come in like the tide. One man passed out and hit his head while coughing because of lisinopril. A woman took an ACE inhibitor for years while complaining bitterly to her doctor about the nagging cough. He responded by prescribing cough medicine. She went on to tell us, “When the coughing got so bad that I wet myself, he prescribed a pill for incontinence!” Eventually a new doctor prescribed a different blood pressure medicine and the cough “went away in less than a week.”
What is the Point of This Tirade?
The point, dear reader, is that if so many physicians can misdiagnose an ACE inhibitor cough and prescribe heavy duty cough medicine, allergy medicine, asthma medicine and corticosteroids, something is very wrong with medicine today.
First, these doctors did not warn about the cough when they wrote the prescription. Second, they did not diagnose the problem promptly as caused by their prescription and third, they did not withdraw the offending drug promptly. Remember, this is such a common complication that every medical student must learn about this side effect. It is clearly described in the official prescribing information.
If the ACE inhibitor cough can be missed, then goodness knows what other drug-induced side effects go undetected or mistreated. Yes, we know that doctors are way too busy these days, but this is too important to overlook. Each year hundreds of thousands of people die because of medical mistakes: misdiagnosis, deadly drug reactions or interactions, hospital acquired infections and other avoidable mishaps.
To find out how to protect yourself or someone you love from such disasters, we suggest our book, Top Screwups Doctors Make and How to Avoid Them. You will learn ways to avoid being misdiagnosed and which drugs people over 65 should avoid like the plague. Warning: they are some of the most popular drugs in the pharmacy. Learn more here. Share your own story below in the comment section and please vote on this article at the top of the page.
