Ramipril Or Reflux - Unsure What Is Causing My Cough

[Bhunabhoy]

Hi

I had a heart attack followed by an angioplasty last month, and I am on the meds listed at the end of this message. In general terms I feel really good since the stent was fitted, and five weeks in I’m walking as much as I used to, but am still taking it easy in terms of strenuous activity. Have had initial meeting at Cardio Rehab, and first physio appointment is this week.

I find that since being on the meds I have developed a dry cough, which occurs in isolated bouts throughout the day, and seems to always occur when I go to bed. The bouts during the day can last for a few seconds or a few minutes, the bout in bed usually lasts for ten minutes or so, then it stops and I am able to get some sleep.

I have experienced acid reflux in the past, and the cough at night was a symptom (although much more prolonged), but then I also experienced a burning sensation in my gullet, and times when my voice became hoarse, symptoms which are not present now. I have tried using Gaviscon to see if the cough will subside, but it does not seem to be making any difference.

I know that a cough is a known side effect of Ramipril, and while my GP nurse told me that she didn’t think it was the cause in my case, because her understanding was that the ‘Ramipril Cough’ is more persistent, my Cardio Rehab nurse has told me that she has knowledge of many other patients who have experienced a cough similar to the one I have when using Ramipril.

I am a bit confused, as I am unsure whether the cough is a symptom of the Ramipril use or the reflux, but I am going to visit my GP at the end of the week to discuss matters. To me it would make sense to try another ACE inhibitor to see if the cough disappears, as I understand that there are alternatives to Ramipril where coughing is not an established side effect. Has anyone on the forum made such a switch in the past? If so, what alternative was prescribed, and did the cough disappear after switching to the new medication?

I would also be interested to know if anyone on the forum has experienced reflux as a result of taking any of the medications shown below, because if it is reflux I’m experiencing at the moment, it is certainly different to how it used to affect me, so I’m wondering if one or more of the medications could be triggering it. Thanks in advance for any knowledge you can share - my journey on the learning curve continues.

My meds:

Aspirin 75mg

Ticagrelor 90mg

Atorvastatin 80mg

Bisoprol Fumarate 1.25mg

Ramipril 2.5mg

[Sb1171]

I managed to catch the thing that cannot be named whilst in hospital following my HA and had a cough as a result. My wife also got it and we both had a residual cough that lasted weeks. Her’s cleared up, mine didn’t and I had this lingering cough wasn’t that bad and only periodical throughout the day, but after a couple of months I mentioned to doctor and was switched to Losartan. Cough cleared up within a couple of weeks.

[Tos92]

I have experienced a dry cough from taking a calcium channel blocker called Verapamil immediate release. Like yours, mine was not persistent but would come in bouts. It was a nuisance more than anything. I then had my medication changed to Verapamil modified release and since then, have not experienced a cough.

I also have chronic heartburn and indigestion. I do not experience a cough with mine, but it is almost always accompanied with a burning sensation in my through and chest. I also feel the reflux coming up into my throat. If you are experiencing this with the cough, then it maybe an indicator that it’s reflux/heartburn. If you are not experiencing this with the cough, it may well be a side effect of the medication, Ramipril.

My heartburn or acid reflux usually disappears temporarily when I take Gaviscon advanced strength in liquid form.

I hope the doctor's appointment goes well and you are able to get down to the bottom of this.

All the best.

Tos

[bee_bear]

I was on the same meds as you after my HA & stent a few months ago. I take Ranolazine too.

My cough was exactly as you describe yours. It went away pretty quickly after swapping from Ramipril to Candesartan.

I was originally on Amlodipine for my hypertension but it gave me the most horrible internal shakes, which is why they put me on the Ramipril instead. So this is my third kind of BP pills & so far so good on the Candesartan!

I have also been suffering digestive issues since my HA. Acid reflux, gall bladder pain, severe bloating, constipation, kidney pain, feeling generally crappy & having dizzy spells..

I've now been put on Lansoprazole 30mg daily.

The Lansoprazole was like a miracle within 24hrs, I felt so much better.

A few days after starting the Lansoprazole I was started on Clopidogrel, as a replacement for Ticagrelor, as the cardiologist thought that might also help to ease my digestive issues.

10 days since the drug changes and I am doing so much better now. All of my horrible symptoms have reduced to a liveable level of discomfort & my cough has gone. I now feel like I expected to feel by now, ready to get stuck into some proper excercise!

I've learned that the advice to talk to your GP about any unpleasant symptoms you're experiencing is really important, don't just put up with them. As everyone says, it can take a while and some fiddling to get your drug mix right for you.

Hope you figure it out soon, so you get yourself some decent rest & feel better. All the best with your GP.

[devonian186]

Best to read the comprehensive leaflet inside each packet that lists possible side effects.

Several of those you named could cause the cough but it is relatively early days since your procedure so might be best to persevere a bit longer but do write down your questions and discuss them with your GP.

[Pouchielou1972]

I had the Rampiril cough and also had the Entresto cough when I swapped to that, but it soon disappeared after my body got used to it.

[Chriswood79]

Hi. From your description it sounds the same as I had on Ramapril. Just these sudden annoying dry coughing fits, particularly in the middle of the night. I persisted for a while to see if my body would settle with then but went to the gp who changed them to Losartan. The cough went within a few days and have came back. Good luck

[Tay99]

Hi there the dry cough will be from the rampril unfortunately its known to cause dry coughs l had one with it very common side effect.

[scentedgardener]

I only took ramipril for a day, it gave me such horrendous indigestion, and worsened my reflux considerably. I changed to Perindopril and haven't had a problem with that. I have been asked a few times why I was on it as apparently it isn't commonly prescribed.I've had reflux and a hiatus hernia for years, it was only Ramipril that affected me.

[NotAllWhoWonder]

almost guaranteed to be the Ramipril (Google “Ramipril Cough”, it’s a very common and annoying side effect). It drove me absolutely bonkers!

[Bhunabhoy]

Thanks so much for all the kind responses, it’s very helpful to get an insight into other peoples’ experiences, and benefit from their knowledge.

[61teapot]

Hi Bhunabhoy

I am on the same meds as you except I have Enalapril not Ramipril and I have a dry cough

GP has given me Lansoprazole to help but I still cough a little at night .

[fishonabike]

Ramipril (an ACEi) cough is well known (as you now know), but ACEi are a bit cheaper than ARBs (e.g. Losartan, Candesartan) which have the same effect, so ACEi are usually the first choice for cost reasons changing to an ARB first should identify wether or not Ramipril is the problem, for most people the cough clears up very quickly

if the cough does not clear up you might then want to see about measures to deal with reflux, this does not always involve moving straight to medication like Omeprazole/Lanzoprazole but if you are happy to take them and they help that's fine

[Bhunabhoy in reply to fishonabike]

Hi

Thanks for this, and for the info about ARBs. My hunch was that if lots of people are being prescribed Ramipril even though some end up with a cough, then it’s being done for economic reasons. I’ll find out what the GP’s views are on Friday.

[Qualipop]

You are on teyh standard set of meds. The only thing i can see there to cause a dry cough is the well known ramipril. My husband has persistent acid reflux that causes no cough or burning pain or indigestion at all but it is slowly damaging his voice box. He refuses to take protective medication because he says he has no stomach problems. I notice that you don't have anything there to protect your stomach.Omeprazole is usually given because of the aspirin.

[Bhunabhoy]

Hi

I’d like to avoid using PPIs if possible. My stomach seems fine on the meds regime, and I am unsure if the cough is linked to the Ramipril or is a symptom of reflux. Will hopefully use a process of elimination to find out if it is the Ramipril, will see what the doc says.

[lizzieloo2]

My husband was put on Ramipril 2.5mg x 2 daily following a heart attack and stent fitted. It made him cough, especially at night and his GP switched him to Losartan 50mg to take at night. This seems to have solved the cough problem

[Bhunabhoy in reply to lizzieloo2]

Thanks for the tip. Losartan has been mentioned in an earlier reply, I’ll see what the doc offers as an alternative.

[Essexgirl63]

When I was in Ramipril I only had that dry tickly cough at night.