The short answer: The only treatment that reliably ends an ACE inhibitor cough is stopping the drug, and that is a decision to make with your prescriber, not on your own. Most people are switched to an angiotensin receptor blocker (ARB) such as losartan, which rarely causes the same cough. After the ACE inhibitor stops, the cough usually fades within 1 to 4 weeks, though it can take up to 3 months.
Why do ACE inhibitors cause a dry cough?
ACE inhibitors (lisinopril, enalapril, ramipril, benazepril and others) lower blood pressure by blocking angiotensin-converting enzyme. That same enzyme also breaks down bradykinin and substance P, two chemicals that irritate the airway. When the enzyme is blocked, they build up in the upper airway and lungs and set off a cough reflex.
The American College of Chest Physicians (ACCP) guideline on ACE inhibitor cough describes this cough as a class effect. That means every drug in the group can cause it. The FDA label for lisinopril says the same: a "persistent nonproductive cough has been reported with all ACE inhibitors."
The typical pattern is easy to recognize:
- It is dry. You do not bring up mucus.
- It often feels like a tickle or scratch in the throat.
- It can start within hours of the first dose or months after you began the drug, per the ACCP review.
- Cough medicine usually does little for it.
How common is ACE inhibitor cough?
Estimates vary a lot by how the question is asked. The ACCP guideline reports an incidence of 5% to 35% across studies. A Singapore primary care study cites a usual range of 5% to 20%. It also found that 30.4% of 424 new ACE inhibitor users stopped the drug because of cough.
Controlled trials show lower numbers. In the lisinopril label's hypertension trials, cough occurred in 3.5% of people on lisinopril versus 1.0% on placebo. In a large observational analysis of nearly 3 million people, reported by the American Heart Association, ACE inhibitor users were 32% more likely to develop a cough than ARB users.
A 2020 review in the Indian Heart Journal notes that the rate differs between individual ACE inhibitors, and was lowest with perindopril in the studies it reviewed. It also reports cases where the cough went away even though the drug was continued. That does not happen for most people, so do not count on it.
Does switching to an ARB stop the cough?
For most people, yes. ARBs such as losartan, valsartan and olmesartan work on the same hormone system but do not block the enzyme that clears bradykinin. The ACCP guideline states that cough with ARBs appears similar to that of the comparison drug in trials.
The FDA label for losartan describes two double-blind trials in people who already had a proven ACE inhibitor cough. Each person was rechallenged with lisinopril first, and their cough went away on placebo. Then they were randomized for up to 8 weeks:
- Study 1: cough in 17% on losartan, 25% on hydrochlorothiazide, and 69% on lisinopril.
- Study 2: cough in 29% on losartan, 35% on placebo, and 62% on lisinopril.
In other words, losartan's cough rate matched a water pill or a sugar pill. The label also notes that cases of cough, including positive rechallenges, have been reported with losartan after approval. So a small number of people still cough on an ARB.
ARBs are not the only option. Thiazide diuretics and calcium channel blockers are also first-line blood pressure drugs. Our guide to blood pressure medications compared walks through the trade-offs. If a calcium channel blocker comes up, read about amlodipine and ankle swelling first, since that is its best-known side effect.
How long does the cough last after stopping the ACE inhibitor?
According to the ACCP guideline, the cough typically resolves within 1 to 4 weeks after the drug is stopped. In some people it lingers for up to 3 months. The lisinopril label says the cough is "almost always resolving after discontinuation of therapy."
That slow fade matters. Many people switch drugs, still cough two weeks later, and assume the switch failed. Give it time before you judge the new medicine. If the cough is still there after 3 months off the ACE inhibitor, something else is probably driving it.
The ACCP guideline also notes that in a minority of people, the cough does not come back when an ACE inhibitor is restarted. Your prescriber may weigh this if an ACE inhibitor has a strong reason to be on your list.
What can you do while you wait to see your prescriber?
Do not just stop the pill. Blood pressure can rise when a drug is stopped without a plan, and some people take an ACE inhibitor for heart failure, a past heart attack, or kidney protection. The 2025 AHA/ACC guideline, as summarized in a 2026 review, prefers an ACE inhibitor or ARB for people with diabetes and kidney disease with albuminuria or reduced kidney function.
Practical steps that help the visit go well:
- Note when the cough started and when you began or changed the ACE inhibitor.
- Track whether it is dry, worse at night, or tied to a cold, reflux or allergies.
- Keep a short log of home readings (see whether to take blood pressure pills morning or night for timing questions).
- Ask directly: "Can I switch to an ARB or another class?"
The ACCP guideline says that, apart from stopping the drug, some medicines have been shown to lessen the cough in studies. None works as reliably as stopping, so ask your prescriber before trying anything. It is also worth ruling out other causes. Asthma, reflux, postnasal drip and infections cause dry coughs too, and the ACCP notes that an ACE inhibitor can be a partial cause alongside them. If you are sorting through symptoms, symptom.md covers other common causes of cough.
When is a cough or throat symptom an emergency?
A dry cough is a nuisance, not a danger. Swelling is different. ACE inhibitors can cause angioedema, a rapid swelling of the face, lips, tongue or throat. The lisinopril label says it "may occur at any time during treatment," reports it in 0.1% of patients, and notes it is more common in Black patients. It warns that swelling of the throat or larynx can block the airway and can be fatal.
Get emergency care right away for:
- Swelling of the face, lips, tongue or eyes.
- Trouble swallowing or breathing.
- A feeling of swelling or tightness in the throat.
The label tells patients to report these signs immediately and to take no more of the drug until they speak with the prescriber. It also describes rare intestinal angioedema, which shows up as belly pain with or without nausea or vomiting. After ACE inhibitor angioedema, the drug class should not be restarted. The lisinopril label lists that history as a contraindication.
The bottom line
An ACE inhibitor cough is common, harmless, and fixable. Stopping the drug is the only treatment that works reliably, and switching to an ARB like losartan works for most people. Expect the cough to fade over 1 to 4 weeks, sometimes up to 3 months. Talk to your prescriber before you stop anything. Treat any swelling of the lips, tongue or throat as an emergency.
Last updated: September 2026. This article is for informational purposes only and does not constitute medical advice. Do not stop or change a blood pressure medicine without talking to your prescriber, and seek emergency care for facial or throat swelling.