A recent analysis highlights a potential side effect of GLP-1 receptor agonists (GLP-1s) that we should be aware: an elevated risk of chronic cough.
By IDS intern Amber Jackson, RN, DCESThis article and its findings focus on people with type 2 diabetes using GLP-1 medications for diabetes management, but the potential side effects may apply to anyone taking these drugs.
Key Findings
- Higher cough risk overall: People with type 2 diabetes prescribed GLP-1s were more likely to develop chronic cough than those using other diabetes medications.
- Risk persists without GERD: The elevated risk remained even after excluding patients with a prior GERD diagnosis, suggesting the mechanism extends beyond typical reflux.
- Known GI effects, new coughing concern: GLP-1 RAs are already known for gastrointestinal side effects, but new findings point to reflux-related pathways that may contribute specifically to chronic cough.
Long-Acting vs. Short-Acting GLP-1 Medications
- Long-acting (once weekly) GLP-1s were associated with a significantly increased hazard (11%; Adjusted HR 1.11 (95% CI 1.07–1.16)) [1].
- Short-acting (daily) GLP-1s showed no significant association (Adjusted HR 0.79 (95% CI 0.44–1.41)) [1].
Study limitation: Researchers note the analysis may have been underpowered for short-acting agents. No objective cough measures (such as validated cough scores or automated cough monitoring) were included.
What Might Be Causing the Cough?
Researchers suggest the findings may be driven by reflux-mediated cough pathways, particularly:
- Laryngopharyngeal reflux (LPR)
- Chronic microaspiration
Both are well-established contributors to chronic cough. Because GLP-1 RAs can delay gastric emptying and alter upper GI function, their rapidly expanding use may be linked to an increased incidence of reflux-related cough symptoms.
Treatment Approaches You May Need to Adjust
Traditional treatments that focus solely on suppressing stomach acid—such as proton pump inhibitors (PPIs)—may not be sufficient for managing cough in people taking GLP-1 drugs.
The researchers suggest that more effective approaches may include:
- Behavioral reflux precautions
(e.g., smaller meals, avoiding late-night eating, positional strategies) - Prokinetic agents
(to improve gastric emptying and reduce reflux events) - Neuromodulators
(for chronic cough hypersensitivity) - Voice therapy
(particularly helpful in LPR-associated throat symptoms)
These options target the airway and motility pathways more directly than acid suppression alone.
Why This Matters
GLP-1 medications remain highly effective for glucose management, weight loss, and cardiometabolic benefits. But for individuals experiencing new or persistent cough, understanding the potential mechanism—and available treatment options—can help clinicians tailor therapy more precisely.
[1] Monaco, K. (2025, November 26). [Is Chronic Cough Another Side Effect of GLP-1 Drugs?]. MedPage Today. https://www.medpagetoday.com/endocrinology/diabetes/118754
