BACKGROUND: Dry cough is a common side-effect of the angiotensin converting enzyme inhibitors (ACEI) and is a major limiting factor of their use. It has been suggested that ACEI cause this side-effect by potentiation of the bradykinin effect. Previous work in our laboratory has shown that noscapine, an antitussive drug, inhibits the effect of bradykinin. METHODS: To investigate the effect of noscapine on ACEI-induced cough, 611 hypertensive patients who were being treated with ACEI were evaluated for the incidence of persistent dry cough. RESULTS: A cough had developed in 65 (10.6%) patients, two (3.1%) of whom also had severe respiratory distress that required hospitalisation and immediate discontinuation of the ACEI. Forty-two (64.6%) patients had developed a mild cough and 21 (32.3%) patients had developed a moderate to severe cough. The patients with moderate to severe cough received 15 mg of noscapine, orally three times daily, while they continued ACEI. Noscapine effectively resolved the cough in 19 (90%) patients within 4-9 days of starting treatment. CONCLUSION: Noscapine, possibly by inhibition of bradykinin synthesis, eliminates ACEI-induced cough in the majority of patients and allows them to continue with ACEI therapy.
BACKGROUND:Dry cough is a common side-effect of the angiotensin converting enzyme inhibitors (ACEI) and is a major limiting factor of their use. It has been suggested that ACEI cause this side-effect by potentiation of the bradykinin effect. Previous work in our laboratory has shown that noscapine, an antitussive drug, inhibits the effect of bradykinin. METHODS: To investigate the effect of noscapine on ACEI-induced cough, 611 hypertensivepatients who were being treated with ACEI were evaluated for the incidence of persistent dry cough. RESULTS: A cough had developed in 65 (10.6%) patients, two (3.1%) of whom also had severe respiratory distress that required hospitalisation and immediate discontinuation of the ACEI. Forty-two (64.6%) patients had developed a mild cough and 21 (32.3%) patients had developed a moderate to severe cough. The patients with moderate to severe cough received 15 mg of noscapine, orally three times daily, while they continued ACEI. Noscapine effectively resolved the cough in 19 (90%) patients within 4-9 days of starting treatment. CONCLUSION:Noscapine, possibly by inhibition of bradykinin synthesis, eliminates ACEI-induced cough in the majority of patients and allows them to continue with ACEI therapy.