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Why Doesn't Losartan Cause the Same Cough as Lisinopril?

Losartan is much less likely than lisinopril to cause the dry, tickling cough that some people on ACE inhibitors develop, and the difference comes down to how each drug works.

Why Doesn't Losartan Cause the Same Cough as Lisinopril?
MedicationsACE inhibitors vs ARBscomparison
Written By: DocAi Health Editorial Team
Last Updated: 2026-09-30
Medical Disclaimer: This article is for general informational and educational purposes only and is not medical advice. It does not create a doctor-patient relationship and is not a substitute for professional diagnosis or treatment by a qualified healthcare provider. Never disregard or delay seeking professional medical advice because of something you have read here. If you think you may have a medical emergency, call 911 or your local emergency number right away. Health information can change and this guidance is general and US-focused, so consult a licensed clinician in your own country about your specific situation.
Losartan is much less likely than lisinopril to cause the dry, tickling cough that some people on ACE inhibitors develop, and the difference comes down to how each drug works. Lisinopril blocks angiotensin-converting enzyme (ACE), which also helps break down a compound called bradykinin in the lungs and airways. The main explanation involves ACE inhibition and reduced breakdown of bradykinin and other cough-promoting compounds. Losartan blocks the angiotensin II receptor instead, so it does not inhibit ACE or produce the same bradykinin buildup. This article covers the mechanism, how common the cough is, and your options if it happens to you.

Two Blood Pressure Drugs, One Hormone System, Different Points of Attack

Lisinopril and losartan both act on the same hormone system in your body, called the renin-angiotensin system, but they interrupt it at different points. This system controls how much your blood vessels narrow and how much fluid your kidneys hold onto, both of which raise blood pressure when the system is overactive.
Lisinopril belongs to a class called ACE inhibitors. ACE stands for angiotensin-converting enzyme, the enzyme that converts an inactive hormone called angiotensin I into the active form, angiotensin II. Angiotensin II is what actually narrows blood vessels and raises blood pressure. By blocking the enzyme, lisinopril reduces how much angiotensin II your body makes in the first place.
Losartan belongs to a different class, called angiotensin II receptor blockers, or ARBs. Instead of reducing how much angiotensin II gets made, losartan blocks the receptor that angiotensin II attaches to on blood vessel walls. Angiotensin II can still be present in your bloodstream. It simply has nowhere to act.
Both approaches lower blood pressure. For nonpregnant people who have diabetes, high blood pressure, and protein in the urine (albuminuria), Section 11 of the 2026 Standards of Care in Diabetes recommends either an ACE inhibitor or an ARB, and says that if one class is not tolerated, the other should be substituted. The cough difference comes from what lisinopril does to the ACE enzyme, an effect losartan does not share.

How Bradykinin Is Linked to the Lisinopril Cough

The enzyme lisinopril blocks, ACE, has a second job besides making angiotensin II. It also breaks down a different compound called bradykinin, a substance that is normally cleared from your lungs and airway tissue at a steady rate.
When ACE is blocked, bradykinin is no longer broken down as efficiently, so it can build up in the airways, along with substance P, another cough-promoting compound that ACE helps clear. These compounds can make the nerve endings in the lining of your throat and lungs more sensitive, which is a widely accepted explanation for the dry, tickling cough associated with ACE inhibitors like lisinopril. The exact mechanism is not fully understood.
This cough often has a recognizable pattern. It is usually dry, without mucus, and it often feels like a tickle or scratch in the back of the throat rather than coming from the chest. It can start soon after you begin lisinopril or many months later, and it can happen whether or not your blood pressure is well controlled. A cough that gets worse when you lie down, or that comes with swelling in your legs, can also be a sign of heart failure, so contact your clinician promptly rather than assuming the medicine is the cause, as MedlinePlus advises.

Why Losartan Is Much Less Likely to Cause the Same Cough

Losartan does not block the ACE enzyme, so it does not slow the breakdown of bradykinin the way lisinopril does. Blocking the angiotensin II receptor, the step losartan acts on, happens downstream of where bradykinin is affected, so that pathway is left alone.
That is why losartan and the other ARBs, drugs like valsartan, olmesartan, and irbesartan, are much less likely to cause this particular cough. The FDA labeling for losartan describes two trials in people who had already had a typical ACE inhibitor cough. Cough was reported by 17% to 29% of those given losartan, similar to the 25% to 35% given a comparison treatment (hydrochlorothiazide or placebo), and by 62% to 69% of those given lisinopril again. The comparison groups show that people also cough for other reasons, so a cough alone does not prove the medicine is the cause.
Switching to an ARB is a common alternative when an ACE inhibitor causes a persistent, bothersome cough and the person still needs this kind of medicine for blood pressure or kidney protection.

Other ACE Inhibitors Can Cause the Same Cough

Lisinopril is not the only ACE inhibitor tied to this cough. It is considered a class effect, so the same explanation applies to other drugs in the class, including enalapril, ramipril, benazepril, quinapril, and captopril. If you have already had a cough on one ACE inhibitor, switching to another is often not enough to solve the problem, since they all block the same enzyme.
If the cough is confirmed to be ACE inhibitor-related and is bothersome, switching to a different class such as an ARB (losartan, valsartan, or candesartan, for example) is commonly considered.

How Common Is the Lisinopril Cough, Really

The ACE inhibitor cough is one of the more recognized reasons people stop taking this class of medication, but it affects a minority of the people who take them, and reported rates vary widely. The FDA labeling for losartan describes it as occurring in a few percent of people on ACE inhibitors, while the National Kidney Foundation puts the figure at around 10%, compared with about 3% for ARBs. It has been reported more often in women and in people of East Asian ancestry, but these group patterns cannot tell you whether you will develop it.
It is not related to how effective the medication is at controlling your blood pressure, and it is not a sign that lisinopril has stopped working. It is a side effect of how the drug works, and it can show up in someone whose blood pressure numbers look great.

What to Do If You Develop a Cough on Lisinopril

Do not stop taking lisinopril on your own if you develop a cough. Stopping a blood pressure medication abruptly can cause your blood pressure to rise back to where it started, and in some cases medications like this are also protecting your kidneys, which matters even if your blood pressure looks fine on the medication.
Instead, call your prescriber and describe the cough: when it started, and whether it is dry or comes with mucus, fever, or other symptoms. A new cough can have many causes, so your clinician should determine whether lisinopril is actually responsible before changing treatment. MedlinePlus lists allergies, asthma, infections, sinus drainage, and acid reflux among the common causes of cough. A cough with fever or coughed-up blood needs its own evaluation.
If your prescriber concludes that the ACE inhibitor is responsible and the cough is bothersome, switching to a different class such as an ARB is commonly considered. The timing of any change is your prescriber's decision.
The cough usually improves after the ACE inhibitor is stopped, but resolution can take several weeks and occasionally longer.

What to Tell Your Prescriber Before Your Appointment

A short list of details helps your prescriber sort out an ACE inhibitor cough from something else at your visit. Note when the cough started in relation to when you began lisinopril, whether it is dry or brings up mucus, whether you have a fever, and whether it changes when you lie down or first thing in the morning.
It also helps to mention any other new medications you have started around the same time, including over-the-counter pain relievers, potassium supplements, and salt substitutes, whether you smoke or have recently quit, whether you have ever had a similar cough on a different ACE inhibitor, and whether you are or could become pregnant. None of this requires a special appointment. A phone call or a message through your patient portal is a reasonable first step, and your prescriber will tell you if they want to see you in person.

Losartan Has Its Own Side Effects to Watch For

Switching to losartan does not mean switching to a medication with no side effects of its own. Both ACE inhibitors and ARBs can raise blood potassium levels, because both reduce the activity of aldosterone, a hormone that normally helps your kidneys get rid of extra potassium. The FDA labeling for lisinopril lists kidney problems, diabetes, potassium-sparing diuretics, potassium supplements, and potassium-containing salt substitutes as risk factors for high potassium. NSAIDs such as ibuprofen or naproxen can also strain the kidneys in some people who take these medicines, so tell your clinician about any NSAID use.
Your clinician will usually check kidney function and potassium after starting or changing an ACE inhibitor or ARB, with the timing based on your kidney function, potassium level, dose, and other medications. The 2026 Standards of Care in Diabetes likewise call for monitoring at the start and periodically as clinically appropriate. Keep those blood tests on your schedule. High potassium can cause no symptoms, but a racing, pounding, or irregular heartbeat combined with muscle weakness or tingling needs emergency care, and a noticeable drop in how much you urinate should be reported promptly.
Other losartan side effects can include dizziness, especially when you first start it or stand up quickly, tiredness, and occasionally a drop in blood pressure that feels like lightheadedness. These effects often ease as your body adjusts, but tell your prescriber if they continue. Fainting, or severe dizziness or confusion that comes on suddenly, can point to a much larger drop in blood pressure and needs emergency care.

Angioedema Is Rare, but It Is Much More Strongly Linked to ACE Inhibitors

There is one serious reaction that has been reported with both ACE inhibitors and ARBs, called angioedema, though it happens much less often than the cough. This is swelling that develops under the skin, most often around the face, lips, tongue, or throat, and it can affect breathing if the swelling reaches the airway. A hoarse or muffled voice can be an early sign that the throat is involved, and the lisinopril labeling notes that angioedema can occur at any time during treatment.
Angioedema from an ACE inhibitor is also thought to involve bradykinin buildup, the same molecule behind the cough, and ACE inhibitors are much more strongly associated with it than ARBs. Rare cases have been reported with ARBs too, some in people who had previously had angioedema on an ACE inhibitor, according to the losartan labeling. A history of angioedema on an ACE inhibitor therefore does not make a switch to an ARB automatic. An ARB is sometimes still used, but only after your prescriber weighs the risks. Anyone who has ever had swelling of the face, lips, tongue, or throat while taking either type of medication should tell their prescriber before starting the other one.
A severe allergic reaction, with sudden trouble breathing, wheezing, or chest tightness soon after a dose, also needs emergency care.

Switching From Lisinopril to Losartan: What Actually Changes

For many people, switching from lisinopril to losartan relieves the cough, because the cough usually improves once the ACE inhibitor is stopped. Losartan can provide effective blood pressure control for many people who cannot tolerate lisinopril, but the dose and your response need to be monitored after the switch. What does not change is the rest of managing high blood pressure: sodium intake, physical activity, other medications, and follow-up blood pressure checks.
Your prescriber will determine when to stop lisinopril and when to start losartan based on your indication, blood pressure, kidney function, and other medications. If your blood pressure readings climb during the switch, or the cough has not clearly improved after several weeks, call your prescriber again rather than waiting it out, since a cough that persists after stopping lisinopril may have a different cause worth checking.

Lisinopril and Losartan Are Generally Not Taken Together

Taking an ACE inhibitor and an ARB together may seem like extra benefit, but it usually does not work that way. Combining them is associated with a higher risk of low blood pressure, high potassium, and kidney problems. In a large trial of people with type 2 diabetes and kidney disease, adding lisinopril to losartan brought no added benefit on the main outcomes measured but more high potassium and acute kidney injury, and the FDA labeling advises avoiding combined use in general. The National Kidney Foundation gives the same advice. Do not take lisinopril and losartan together unless a specialist has specifically instructed you to. If you have been prescribed both, or you still have lisinopril at home after a switch, ask your prescriber or pharmacist which one you should be taking.

Pregnancy Is an Important Exception

ACE inhibitors and ARBs are not used during pregnancy because they can harm the developing baby. The boxed warning in the losartan labeling says to discontinue the medicine as soon as pregnancy is detected, and MedlinePlus carries a similar warning for lisinopril. If you are pregnant, think you might be, or plan to become pregnant, call your prescriber right away so they can arrange a safer plan for your blood pressure. Our guide to medications in pregnancy covers other medicines.

When to Seek Medical Care

When to Seek Urgent or Emergency Care

A cough on lisinopril is often an annoying side effect rather than a dangerous one, but a new cough can have other causes. A small number of symptoms tied to these medications need care right away. This guidance is in addition to, not a replacement for, the general disclaimer above.

Emergency, call 911 or go to the emergency room immediately if:

  • Swelling of the face, lips, tongue, or throat, or a voice that suddenly sounds hoarse or muffled, especially if breathing or swallowing feels difficult (this can be angioedema, a rare reaction that is more common with ACE inhibitors but can also occur with ARBs)
  • Difficulty breathing, wheezing, or tightness in the chest, especially if it comes on suddenly or soon after taking a dose
  • A racing, pounding, or irregular heartbeat combined with muscle weakness or a tingling feeling, which can signal a dangerous rise in blood potassium
  • Fainting, severe dizziness, or confusion that comes on suddenly, which can point to a steep drop in blood pressure

See a doctor soon (same-day or next available appointment) if:

  • A new dry cough that started after you began lisinopril or another ACE inhibitor and is not going away (do not stop your medicine on your own)
  • A cough that is keeping you up at night or interfering with work, talking, or daily activities
  • New swelling in your hands, feet, ankles, or lower legs after starting either medication, especially with a cough that gets worse when you lie down
  • Ongoing dizziness or lightheadedness when you stand up, or unusual tiredness that is not improving
  • A drop in how much you are urinating, or blood work that shows reduced kidney function or a high potassium level
  • A cough with fever or coughed-up blood, which needs its own evaluation
  • You are pregnant, think you might be, or plan a pregnancy while taking lisinopril or losartan (call your prescriber right away)
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Frequently Asked Questions

Can I just switch from lisinopril to losartan on my own if I develop a cough?

No. Stopping lisinopril abruptly or switching medications without guidance can let your blood pressure climb back up, and in some cases these drugs are also protecting your kidneys. A new cough can have many causes, so call your prescriber, describe the cough, and let them decide whether lisinopril is the likely cause before anything changes. If it is, they can guide a safe switch to losartan or another option.

How long does the lisinopril cough take to go away after stopping the medication?

The cough usually improves after the ACE inhibitor is stopped, but resolution can take several weeks and occasionally longer. If the cough has not clearly improved after several weeks, or it comes with fever or mucus, tell your prescriber, since it may have a different cause. Trouble breathing needs emergency care.

Does losartan ever cause a cough of its own?

It can, but much less often than lisinopril. Because losartan blocks the angiotensin II receptor rather than the ACE enzyme, it does not cause the bradykinin buildup linked to the lisinopril cough. In the trials described in the FDA labeling, cough rates on losartan were similar to placebo or hydrochlorothiazide, although cough has also been reported after approval.

Is the lisinopril cough a sign that something is wrong with my heart or lungs?

A dry cough after starting an ACE inhibitor is often a medication side effect, but a new cough can have many causes. Trouble breathing needs emergency care, and chest pain, fever, coughing up blood, or worsening exercise tolerance need prompt medical evaluation, as does a cough that gets worse when you lie down, especially with leg swelling.

Can I take a cough suppressant instead of switching blood pressure medications?

Cough suppressants do not address the cause of an ACE inhibitor cough and may not help much, since the irritation is thought to come from bradykinin and related compounds building up in the airway tissue. If the cough is bothersome, ask your prescriber about options, which may include switching to a different class such as losartan.

Are losartan and lisinopril equally good at lowering blood pressure?

Both lisinopril and losartan are effective blood pressure medicines, but which one is preferred depends on the reason for treatment, kidney function, potassium, heart failure status, pregnancy considerations, prior side effects, and other factors. Your prescriber chooses based on your health history, other medications, insurance coverage, and how your body responds to each drug.

Why do only some people get a cough from lisinopril and not others?

Researchers do not have a complete answer. The cough has been reported more often in women and in people of East Asian ancestry, and individual differences in how the airway responds to bradykinin may play a role, but none of this can predict who will develop the cough.
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