During a New Medicines Service review, a 47-year-old man with type 2 diabetes and hypertension reports a dry cough since starting a medication. He takes metformin, ramipril, and atorvastatin. What is the most appropriate action?

• A. Suggest contacting his GP to change ramipril to losartan
• B. Advise to continue current regimen
• C. Recommend a different ACE inhibitor
• D. Recommend OTC cough suppressant

Answer: (A)

This question tests recognizing an ACE inhibitor–associated cough and how to manage it. Dry cough is a known adverse effect of ACE inhibitors like ramipril, caused by the buildup of bradykinin in the airways. Since the cough began after starting ramipril, it’s likely related to the medication. Switching to an angiotensin II receptor blocker (ARB) such as losartan avoids the bradykinin increase and often resolves the cough while preserving blood pressure control.

Therefore, the most appropriate action is to request a change from ramipril to losartan. Other options don’t address the cause: continuing the current regimen lets the cough persist; an OTC cough suppressant treats symptoms but not the underlying cause; and trying another ACE inhibitor would likely produce the same cough.