Cough causes loss of control

Q. I’ve had a terrible cough, so violent that I’ve wet and sometimes even soiled myself. For the past several weeks, I’ve been vomiting from coughing so hard. I take lisinopril and amlodipine for high blood pressure. I suspect that one of them is the cause of my horrid cough. Is this possible?

A. The most common and bothersome side effect of popular blood-pressure drugs such as benazepril, captopril, enalapril, fosinopril, lisinopril and ramipril is an uncontrollable cough. Many readers have reported throwing up because of this side effect. Patients always should be alerted to this potential adverse reaction.

We are sending you our Guide to Blood Pressure Treatment with a discussion of the pros and cons of a range of medications and many nondrug alternatives. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (64 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. B-67, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

Although amlodipine is unlikely to cause cough, it can lead to swollen ankles because of fluid retention. Other side effects may include headache, dizziness, nausea and fatigue.

Q. My family has switched almost entirely to using sea salt in cooking. Are we now at greater risk of developing a goiter because we’re not using iodized salt?

A. You are correct that sea salt contains minimal iodine. If you don’t get iodine from other sources, you might develop a goiter — an enlarged thyroid gland that is working overtime to produce thyroid hormone.

The Recommended Dietary Allowance of iodine is 150 micrograms per day for an adult. You can get adequate amounts by eating fish, dairy products or baked potatoes. Kelp (seaweed) is highest in iodine. Many multivitamins contain iodine.

Q. Your advice on getting off acid-suppressing drugs (PPIs) makes it clear you’ve never experienced rebound reflux. I am a nurse, and I take omeprazole, lansoprazole or whatever other PPI I can get.

I just laughed at your suggestion that “gradual tapering might be beneficial.” Rebound reflux is unlike any heartburn you’ve ever experienced; it is much worse than reflux before PPIs. Nothing touches it. It is the most fierce, insistent pain you can imagine. The only thing that stops it is taking another PPI pill. I have tried tapering, but I can never get much past a day before I need more. Tums and Rolaids have absolutely no effect. Someone needs to look into this and try to figure out how those of us who were prescribed Prilosec and other PPIs 15 years ago can stop taking them.

A. Gastroenterologists disagree about the difficulty of stopping an acid-suppressing drug such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) and rabeprazole (Aciphex). A Danish study (Gastroenterology, July 2009) found that people without heartburn experienced distressing reflux after stopping proton pump inhibitors (PPIs). Other specialists, however, are skeptical (Editorial, American Journal of Gastroenterology, July 2010). Suggestions for stopping PPIs with ginger, DGL and probiotics can be found at www.PeoplesPharmacy.com.

2011 King Features Syndicate, Inc.