Perindopril-Induced Cough Treated with Ibuprofen: A Case Report and Review of Literatures

Background:Cough is a well-known adverse reaction to the use of angiotensin converting enzyme inhibitors. The currently accepted treatment for such medical condition is to stop using the offending drug and switch to an alternative. However, several drugs have shown some success in reducing or eliminating angiotensin converting enzyme inhibitors(ACEIs)-induced cough.
Case description:A 41-year-old malerecently diagnosed as a case of stage 1 hypertension. The patient developed dry cough after 3 months of using perindopril. Night attacks were frequent and interfered with his normal sleep. Withholding perindopril and the use of dextromethorphan was ineffective for about 2 weeks. Past history was irrelevant and clinical examination was unremarkable. Chest X-ray was normal as well as all basic investigations. Concomitant use of ibuprofen, for a different indication, had a noticeable effect in reducing cough and allowed the patient to sleep. Recovery was accelerated by the use of such non-selective non-steroidal anti-inflammatory drug.
Conclusions:The ability of ibuprofen to inhibit both cyclo-oxygenase-1 and cyclo-oxygenase-2 could, at least theoretically, explain its significant effect on ACEIs-induced cough as both enzymes are involved in the pathogenesis of this medical condition. Still, a well-designed randomized controlled study is needed to confirm the finding of this case report.