Angiotensin II Receptor Blocker (ARB)/NSAIDs Interactions
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
The cause of the interaction is not known.
What might happen:
The effects of your blood pressure medicine may decrease. Your blood pressure may increase, causing headache, dizziness, or blurred vision. Your kidneys may not work as well.
What you should do about this interaction:
If your blood pressure does increase, contact your doctor. It may be necessary to change the dosage of your blood pressure medicine or change your pain medicine.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this drug interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
- 1.Swartz SL, Williams GH. Angiotensin-converting enzyme inhibition and prostaglandins. Am J Cardiol 1982 Apr 21;49(6):1405-9.
- 2.Cleary JD, Taylor JW. Enalapril: a new angiotensin converting enzyme inhibitor. Drug Intell Clin Pharm 1986 Mar;20(3):177-86.
- 3.Abe K, Ito T, Sato M, Haruyama T, Sato K, Omata K, Hiwatari M, Sakurai Y, Imai Y, Yoshinaga K. Role of prostaglandin in the antihypertensive mechanism of captopril in low renin hypertension. Clin Sci (Lond) 1980 Dec;59 Suppl 6:141s-144s.
- 4.Abe K, Itoh T, Imai Y, Sato M, Goto T, Otsuka Y, Yoshinaga K. Indomethacin inhibits the antihypertensive effect of captopril, SQ 14225, in low renin hypertension. Tohoku J Exp Med 1980 Sep;132(1):117-8.
- 5.Moore TJ, Crantz FR, Hollenberg NK, Koletsky RJ, Leboff MS, Swartz SL, Levine L, Podolsky S, Dluhy RG, Williams GH. Contribution of prostaglandins to the antihypertensive action of captopril in essential hypertension. Hypertension 1981 Mar-Apr;3(2):168-73.
- 6.Fujita T, Yamashita N, Yamashita K. Effect of indomethacin on antihypertensive action of captopril in hypertensive patients. Clin Exp Hypertens 1981;3(5):939-52.
- 7.Ogihara T, Maruyama A, Hata T, Mikami H, Nakamaru M, Naka T, Ohde H, Kumahara Y. Hormonal responses to long-term converting enzyme inhibition in hypertensive patients. Clin Pharmacol Ther 1981 Sep;30(3):328-35.
- 8.Silberbauer K, Stanek B, Templ H. Acute hypotensive effect of captopril in man modified by prostaglandin synthesis inhibition. Br J Clin Pharmacol 1982;14 Suppl 2:87S-93S.
- 9.Salvetti A, Pedrinelli R, Magagna A, Ugenti P. Differential effects of selective and non-selective prostaglandin-synthesis inhibition on the pharmacological responses to captopril in patients with essential hypertension. Clin Sci 1982;63(Suppl 8):261s-3s.
- 10.Gilchrist NL, Richards AM, March R, Nicholls MG. Effect of sulindac on angiotensin converting enzyme inhibitor-induced cough: randomised placebo-controlled double-blind cross-over study. J Hum Hypertens 1989 Dec;3(6):451-5.
- 11.Ohya Y, Kumamoto K, Fujishima M. Effects of crossover application of sulindac and azelastine on enalapril-induced cough. J Hum Hypertens 1992 Feb;6(1):81-2.
- 12.Allon M, Pasque CB, Rodriguez M. Interaction of captopril and ibuprofen on glomerular and tubular function in humans. Am J Physiol 1990 Aug;259(2 Pt 2):F233-8.
- 13.Allon M, Pasque CB, Rodriguez M. Acute effects of captopril and ibuprofen on proteinuria in patients with nephrosis. J Lab Clin Med 1990 Oct; 116(4):462-8.
- 14.Minuz P, Lechi A, Arosio E, Degan M, Capuzzo MG, Lechi C, Corsato M, Dalla Riva A, Velo GP. Antihypertensive activity of enalapril. Effect of ibuprofen and different salt intakes. J Clin Hypertens 1987 Dec; 3(4):645-53.
- 15.Polonia J, Boaventura I, Gama G, Camoes I, Bernardo F, Andrade P, Nunes JP, Brandao F, Cerqueira-Gomes M. Influence of non-steroidal anti-inflammatory drugs on renal function and 24h ambulatory blood pressure-reducing effects of enalapril and nifedipine gastrointestinal therapeutic system in hypertensive patients. J Hypertens 1995 Aug; 13(8):925-31.
- 16.Morgan TO, Anderson A, Bertram D. Effect of indomethacin on blood pressure in elderly people with essential hypertension well controlled on amlodipine or enalapril. Am J Hypertens 2000 Nov;13(11):1161-7.
- 17.Conlin PR, Moore TJ, Swartz SL, Barr E, Gazdick L, Fletcher C, DeLucca P, Demopoulos L. Effect of indomethacin on blood pressure lowering by captopril and losartan in hypertensive patients. Hypertension 2000 Sep; 36(3):461-5.
- 18.Fricker AF, Nussberger J, Meilenbrock S, Brunner HR, Burnier M. Effect of indomethacin on the renal response to angiotensin II receptor blockade in healthy subjects. Kidney Int 1998 Dec;54(6):2089-97.
- 19.Morgan T, Anderson A. Interaction of indomethacin with felodipine and enalapril. J Hypertens Suppl 1993 Dec;11 Suppl 5:S338-9.
- 20.Halawa B. Effect of indomethacin and ibuprofen on blood pressure of patients treated with nifedipine or captopril. Pol Tyg Lek 1993 Apr 5-12; 48(14-15):313-5.
- 21.Espino DV, Lancaster MC. Neutralization of the effects of captopril by the use of ibuprofen in an elderly woman. J Am Board Fam Pract 1992 May-Jun;5(3):319-21.
- 22.Abdel-Haq B, Magagna A, Favilla S, Salvetti A. Hemodynamic and humoral interactions between perindopril and indomethacin in essential hypertensive subjects. J Cardiovasc Pharmacol 1991;18 Suppl 7:S33-6.
- 23.Heeg JE, de Jong PE, de Zeeuw D. Additive antiproteinuric effect of angiotensin-converting enzyme inhibition and non-steroidal anti-inflammatory drug therapy: a clue to the mechanism of action. Clin Sci (Lond) 1991 Sep;81(3):367-72.
- 24.Kirch W, Stroemer K, Hoogkamer JF, Kleinbloesem CH. The influence of prostaglandin inhibition by indomethacin on blood pressure and renal function in hypertensive patients treated with cilazapril. Br J Clin Pharmacol 1989;27 Suppl 2:297S-301S.
- 25.Fogari R, Zoppi A, Carretta R, Veglio F, Salvetti A. Effect of indomethacin on the antihypertensive efficacy of valsartan and lisinopril: a multicentre study. J Hypertens 2002 May;20(5):1007-14.
- 26.Prlesi L, Plakogiannis R. Angioedema after nonsteroidal antiinflammatory drug initiation in a patient stable on an angiotensin-converting-enzyme inhibitor. Am J Health Syst Pharm 2010 Aug 15;67(16):1351-3.
- 27.Kampitak T. Recurrent severe angioedema associated with imidapril and diclofenac. Allergol Int 2008 Dec;57(4):441-3.
- 28.Tekturna (aliskiren) US prescribing information. Novartis Pharmaceuticals Corporation November, 2017.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.