Some blood pressure meds can cause chronic coughs
Q: I have had a chronic dry cough for years. Workups with allergists, pulmonologists and even a gastroenterologist have not turned up the cause. Pulmonary function tests have ruled out asthma or COPD.
My prescriptions include metformin, glimepiride, simvastatin and losartan. The latest is Singulair for the cough, but it hasn’t helped. Do you have any ideas?
A: Most doctors know that ACE inhibitor blood pressure medicines like lisinopril can cause a persistent cough. They may not pay attention to a drug like losartan, an angiotensin receptor blocker (ARB), because they perceive it as unlikely to trigger cough.
Research in rabbits does show that losartan is less likely than lisinopril to cause a cough (Journal of Physiology and Pharmacology, April 2013). Nonetheless, this does seem to be a possible, though less common, side effect of
losartan.
Other readers have reported cough when taking an ARB, and the official prescribing information notes: “Cases of cough, including positive re-challenges, have been reported with the use of losartan in postmarketing experience.”
We don’t know if losartan is causing your cough. However, it would make sense to ask your doctor if you could try a blood pressure medication that is neither an ACE inhibitor nor an ARB.
Q: I read your article about discontinuing daily 81-mg aspirin for those over 65. People with diabetes have been taking aspirin for years because of the increased risk of heart attacks and strokes. Is there any research on the risk of diabetics stopping the 81-mg aspirin?
A: This is an important question that doctors are still asking (JAMA Network Open, June 21, 2021). There have been few studies focused on the risks of discontinuing aspirin for people with diabetes.
One such trial focused on people with Type 2 diabetes (Diabetes Therapy, October 2020). Stopping after short-term aspirin use did not increase the risks or heart attacks, strokes or death after a stent was put in.
However, these individuals kept taking a medicine such as clopidogrel designed to prevent blood clots. That might have helped protect them from rebound clotting after discontinuing aspirin.
Q: I am 13 weeks pregnant. I was constipated for two days, but today I had bad diarrhea. As a result, I developed a super uncomfortable hemorrhoid. Two overthe-counter medicines didn’t work. The pain was horrible. I couldn’t take it anymore, so I told my dad about my problem. He said that my grandpa used to apply Vicks VapoRub. I could hardly believe this,
but I figured what the heck. To my surprise, it worked.
A: Vicks VapoRub is an unorthodox hemorrhoid remedy, but many readers agree with you that it can soothe pain and relieve itching. Others, however, have complained that it produces a feeling of spontaneous combustion in the nether region. One reader described his butt discomfort this way: “Mayday, tail on fire!”
As a result of such comments, we have discouraged use of Vicks on that area of the anatomy. The makers of VapoRub state quite clearly that it is “for external use only” and should not be used “on wounds or damaged skin.”