Dry cough is a well known side effect of ACE inhibitors due to inhibition of metabolism of bradykinin and kallikren system by the same enzyme which converts Angiotensin I into Angiotensin II.
But ARBs have nothing to do with this enzyme so they don't disturb the metabolismof bradykinnin. Why these agents cause dry cough ?
Nice question : ARBs normally do not cause dry cough. It is now well established and your are right on the mechanism. So, if people under ARBs have dry cough, unless they have abnormal kinins, it is time to explore why? It is certainly due 99.99% to something else (more classic, asthma, etc.).
Dear Ali.. Very good question. I totally agreed with Renaud's answar. Cough is extremely rare with ARB because it doesn't interfere with kinin system. Majority of cases of Cough in patients on ARB is because of bronchial asthma or COPD or other respiratory pathology. However some cases of ARB induced cough is reported specially with losartan which respond to discontinuation of losartan. Mechanism may be because of overexpression unopposed of AT2 receptor in central nervous system and some degree of ACE inhibitor like property of losartan. Following link might help you.. Thanks
Dear all, despite the fact Losartan has been said to provoque dry cough, even Sandoz doesn't list it as a side effect. And it has no ACE like effect, strictly impossible. I know that if you look to some web sites the secondary effect : dry cough is listed, but this is a total non official and very improbable effect. Most of the time it is not a standalone prescription... I however agree they could be exceptions.
