Q: I am a 75-year-old male in excellent health and very active. I have allergies – especially in the spring and fall. For the past three weeks I have had a persistent cough and am coughing up cloudy white mucus. My doctor ran a C-scan on my chest which was clear, but indicated some irregularities in my gallbladder. He ran an ultrasound on that and said there were some small stones but nothing that would dictate removal. He explained that my blood pressure medicine, Benicar, could cause the coughing.
I also have acid reflux and take Nexium. He explained that the coughing also might be caused by acid reflux and I could be aspirating it and then coughing it up. He told me to stop taking the Benicar for two weeks and come back to see him He also prescribed Asifex in place of the Nexium. I think the cough is most likely from the acid reflux because the mucus tastes bitter. What’s you opinion?
A: Benicar (olmesartan) is what is known as an angiotensin II receptor antagonis that keeps blood vessels from narrowing, improves blood flow and lowers blood pressure. Side effects may include edema of the extremities, lightheadedness, chest pain, a rapid heart rate, ongoing diarrhea, dizziness, a cough that can produce mucus and more.
Nexium (esomeprazole) is a proton pump inhibitor that decreases the amount of acid produced in the stomach. It is prescribed to treat GERD (gastroesophageal reflux disease) and other related conditions. Side effects may include bloating, chills, an elevated heart rate, fever, shortness of breath, itching, cough, and a great deal more.
Aciphex (rabeprazole) is another proton pump inhibitor prescribed to reduce the amount of acid produced in the stomach. It, too, treats GERD and other conditions involving excess stomach acid.Side effects are, in part, similar to those of Nexium – fever or chills, low back or side pain, paresthesias of the hands or feet, general fatigue, and cough.
Acid reflux is a backward flow of stomach acid into the esophagus. The regurgitation may taste sour and you may experience heartburn (a burning sensation in the chest). Common risk factors may include being obese or overweight, eating spicy/fatty foods, eating large meals and lying down immediately following the meal, taking blood pressure medications/specific muscle relaxants/aspirin or ibuprofen, drinking carbonated beverages or products that contain alcohol, and smoking. On the flip side, the condition may be kept under control through weight loss, avoiding foods that trigger heartburn (that differ from person to person), avoiding alcohol and the smoking habit, and through eating smaller more frequent meals.
Occasional reflux can be treated with over-the-counter medications such as Rolaids, Alka-Seltzer, Mylanta, and others; however, while they may neutralize stomach acid, they may result in diarrhea or constipation – especially with their overuse. The best choice is an antacid that contains both magnesium hydroxide and aluminum hydroxide. When these OTCs fail to help, Pepcid, Tagamet, Zantac, Aciphex, Nexium, and others may provide relief.
While I lean toward acid reflux perhaps being the cause of your productive cough, I cannot place the blame on any specific medication. Your physician is already on the right track through suggesting you discontinue the Benicar and substituting the Nexium for the Aciphex. However, the problem with making more than one change at a time is that you (and he) will be unable to determine which medication is to blame. What appears to me to work well is to discontinue or substitute one drug at a time for a given period. If no relief is found, proceed to the next. In your case, all drugs prescribed thus far have a cough as an unwanted potential side effect. Therefore, in my opinion, you will only be able to determine which is the culprit through the process of elimination. Good luck.
