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RE: [IP] Vasotec (Enalapril) cough


One of the modes of action for all ACE-inhibitors (angiotensin converting
enzyme inhibitor) is to block the conversion of angiotensin to aldosterone.
Aldosterone works by stimulating the kidney to reabsorb as much "water" as
possible, and does this by causing higher solute concentrations in the
collecting tubules of the kidney structure.  One of the side effects, as
previously mentioned by one of the earlier replies, is the accumulation of a
chemical called bradykinin.  Bradykinin is usually consumed in the conversion
of angiotensin to aldosterone, but blocking this conversion leads to a build
up of bradykinin, which feeds back to the lung and in "some" patients can
cause hypersensitivity in the nerves of the pharynx, ultimately leads to a
"dry" cough that is persistent, without any other signs of infection.  If you
are one of these patients who get the "dry cough" it is usually accepted to
simply switch you to an ARB (angiotensin receptor blocker).  This medication
actually sits down on the switch that angiotensin would activate and blocks
it's effects, ultimately leading to the same result of dumping more "water"
from the kidney and therefore lowering blood pressure and decreasing pressure
on the blood supply to the kidney.

Some things to keep in mind.  Only ACE-inhibitors were studied in type I DM,
ARB's were only studied in type II's.  It is assumed that since both act on
the same system they would provide the same nephroprotective effects (i.e.
kidney protection).  This is only an assumption.  No drug company will pay the
money to study the effects of each drug class in the other type of DM because
there is no significant financial gain since doctors already assume a "class
effect" to these medications.  Imagine if the manufacturer of an ACE-i tried
to prove they work as well in Type II's and the data showed they actually
harmed Type II's...all the doctors would pull their patients from those meds
and cost the pharm companies big bucks.  So for now no additional studies are
being conducted to prove a benefit for Type I's on ARB's.

My opinion is that an ACE-i is preferrable if it can be tolerated without
significant side effects.  When it cannot, an ARB can be considered.  There
are actually combination ACE/ARB medications that may offer both the kidney
protection from the ACE for a type I and the blood pressure control from the
addition of the ARB.  Ultimately you need to have this conversation with your
doctor to optimize both kidney protection and blood pressure control (for both
cardio and ocular protection from diabetes).



From: email @ redacted on behalf of
email @ redacted
Sent: Wed 5/21/2008 12:43 PM
To: email @ redacted
Subject: [IP] Vasotec (Enalapril) cough

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 I am taking Enalapril (generic of Vasotec) to lower my blodd presure and
therefore reduce kidney problems. One of the drus side effects can be a dry
cough. In the past I have experenced this side effect for a brief time and it
would stop, However, it has lasted several weeks now.
 I was wondering if anyone else has had a similar experence, and what steps
taken to deal with the cough?
Dx 74, pumping since March 08
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