COUGH INDUCED BY QUINAPRIL WITH RESOLUTION AFTER CHANGING TO FOSINOPRIL

OBJECTIVE: To report a case of chronic, nonproductive cough secondary to the angiotensin-converting enzyme (ACE) inhibitor quinapril, with c omplete resolution after switching to another ACE inhibitor, fosinopri l. DATA SOURCES: All relevant articles from January 1985 through Febru ary 1993 were identified, primarily through MEDLINE search and review of pertinent articles' bibliographies. CASE SUMMARY: A 68-year-old wom an developed a dry, irritating cough within one month of starting quin april therapy for the treatment of essential hypertension. The patient was a nonsmoker with no respiratory illnesses. The cough continued fo r the duration of therapy with quinapril. One month after changing to fosinopril therapy, the patient reported complete resolution of the co ugh. She remains cough-free to date. DISCUSSION: Cough induced by ACE inhibitors is a frequently documented adverse effect. It is severe eno ugh to require discontinuation of therapy in 1-10 percent of patients. The cough is considered to be a class-related adverse effect with cro ss-reactions between ACE inhibitors routinely reported. At this time, changing to another ACE inhibitor or additive therapy with nonsteroida l antiinflammatory drugs is not recommended. Discontinuation of the AC E inhibitor results in rapid alleviation of the cough, although this i s not always necessary, as most patients may experience a cessation or decrease in cough. We report a case of cough following the administra tion of quinapril, with complete resolution after changing to the alte rnative ACE inhibitor fosinopril in a patient with essential hypertens ion. CONCLUSIONS: Cough has been encountered commonly after the admini stration of ACE inhibitors. Frequency of cough is variable and althoug h this complication has been described as a class effect, patients wit h a persistent, severe ACE inhibitor-induced cough may benefit from a trial of fosinopril therapy. This may be particularly useful in patien ts unable to tolerate an alternative class of antihypertensive agents.