Effects of nifedipine and indomethacin on cough induced by angiotensin-converting enzyme inhibitors: a double-blind, randomized, cross-over study

J Cardiovasc Pharmacol. 1992 May;19(5):670-3.


Prostaglandins (PG) have been suggested to play a role in the genesis of cough induced by angiotensin-converting enzyme inhibitors (ACE-I) and that inhibition of PG synthesis can reduce or abolish the incidence of this side effect. Moreover, experimental and clinical data suggest that nifedipine, a dihydropyridine Ca antagonist, can inhibit PG synthesis. Therefore, we wished to determine whether nifedipine can reduce cough induced by ACE-I as compared with indomethacin, a known inhibitor of PG synthesis. Fourteen hypertensive patients who developed cough during captopril chronic therapy randomly received slow-release nifedipine 20 mg twice daily (b.i.d.), indomethacin 50 mg b.i.d., and placebo b.i.d. for 1 week in a double-blind, cross-over design. At the end of each treatment phase, cough was evaluated by a self-administered questionnaire containing an ordinal scale for daily cough intensity and frequency. Indomethacin abolished or markedly reduced cough induced by ACE-I, whereas nifedipine reduced it but to a lesser degree. These findings suggest that PG can play a role in cough caused by ACE-I, and a dihydropyridine Ca antagonist can reduce the occurrence of this side effect.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects*
  • Blood Pressure / drug effects
  • Captopril / administration & dosage
  • Captopril / adverse effects*
  • Cough / chemically induced
  • Cough / drug therapy*
  • Double-Blind Method
  • Female
  • Heart Rate / drug effects
  • Humans
  • Indomethacin / administration & dosage
  • Indomethacin / therapeutic use*
  • Male
  • Middle Aged
  • Nifedipine / administration & dosage
  • Nifedipine / therapeutic use*
  • Prostaglandins / biosynthesis


  • Angiotensin-Converting Enzyme Inhibitors
  • Prostaglandins
  • Captopril
  • Nifedipine
  • Indomethacin