A 65-year-old man has been started on lisinopril. Which adverse drug reaction could potentially occur?

• A. Dry cough
• B. Nausea
• C. Hypokalemia
• D. Rash

Answer: (A)

ACE inhibitors like lisinopril commonly cause a dry, nonproductive cough. This arises because ACE normally helps break down bradykinin; when the enzyme is blocked, bradykinin accumulates in the airways and can irritate cough receptors, leading to a persistent cough that often appears within weeks of starting therapy. It’s a hallmark feature that helps distinguish this drug class from others.

Nausea and rash can occur with various drugs but are not characteristic or distinctive ADRs of lisinopril. Hypokalemia is not typical for ACE inhibitors; these drugs more commonly raise potassium levels (hyperkalemia) by reducing aldosterone. So the adverse effect most likely to be observed with lisinopril is a dry cough. If the cough becomes bothersome, a clinician might consider switching to a different class, such as an angiotensin receptor blocker.