NSAIDs and blood pressure medicines
Also called the triple whammy
Key points about NSAIDs and blood pressure medicines
- Taking anti-inflammatories while you take some blood pressure medicines can damage your kidneys
- A common interaction happens when you take anti-inflammatories while you are taking some blood pressure medicines.
- Taking some medicines together can cause problems. This is called a medicine or drug interaction.
Taking some medicines together can cause problems. This is called a medicine or drug interaction.
A common interaction happens when you take anti-inflammatories while you are taking some blood pressure medicines. ACE inhibitors/angiotensin receptor blockers (ARBs) and diuretics are often used to treat high blood pressure and heart failure. Taking these medicines together is safe, but it is not safe to take them with an anti-inflammatory as well. This can damage your kidneys. Read more about acute kidney injury.
Although using NSAIDs with blood pressure medicines such as beta blockers and calcium channel blockers may be less harmful to your kidneys, NSAIDs must still be used very cautiously by people taking these medicines.
For more information, see NSAIDs learning activity.
Studies have shown that all NSAIDs, except aspirin in low doses, can increase the chance of heart attack or stroke.
- The risk may be greater if you have heart disease or risk factors for heart disease such as smoking, high blood pressure, high cholesterol or diabetes.
- However, the risk of heart attack or stroke may also be increased in people who do not have heart disease or those risk factors.
- Heart problems caused by NSAIDs can happen within the first weeks of use.
- Heart problems may occur more often with higher doses or with long-term use.
- NSAIDs should not be used right before or after heart bypass surgery.
Read more about the risks associated with taking NSAIDs.
Most people have no problem taking anti-inflammatories, but some people are seriously harmed by these medicines. Anti-inflammatory medicines are used for pain from headache, migraine, dental pain, back and muscle pain, arthritis, painful periods and pain following injury. They can help reduce fever, redness and swelling.
You can buy anti-inflammatories at your supermarket or pharmacy without a prescription, so you may take them without realising that they may cause harm to your kidneys.
Read more about NSAIDs and risks of NSAIDs.
| Medicine name | Also called |
| Ibuprofen | Brufen, Ibugesic, I-Profen, Nurofen, Advil, Medix |
| Combination medications | Nurofen Plus, Maxigesic, Nuromol, Brufen extra, Nurofen Cold and Flu, Ibucode Plus,Panfen Plus |
| Naproxen | Noflam, Naprosyn SR |
| Diclofenac | Voltaren, Diclofenac, Diclohexal, Apo-Diclo SR |
| Celecoxib | Celebrex, Celostea |
ACE inhibitors
Most ACE inhibitors have names that end in ‘pril’. The following ACE inhibitors are available in New Zealand. Read more about ACE inhibitors.
| ACE inhibitors available in New Zealand | |
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ACE inhibitors are sometimes combined with a diuretic (water tablet), eg:
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Angiotensin receptor blockers (ARBs)
Most ARBs have names that end in ‘sartan’. The following ARBs are available in New Zealand:
- candesartan
- losartan
- irbesartan.
ARBs are sometimes combined with a diuretic, eg, Karvezide, Arrow-Losartan & Hydrochlorothiazide, Entresto. Read more about ARBs.
Water pills (diuretics)
Diuretics are medicines that help your body get rid of extra salt (sodium) and water. They work by increasing the amount of urine (pee) you make. Read more about diuretics.
| Medicine name | Also called |
| Bendroflumethiazide (bendrofluazide) | Arrow-Bendrofluazide |
| Chlortalidone | Hygroton, Igroton |
| Indapamide | Dapa-Tabs |
| Metolazone | Zaroxolyn, Metenix |
| Furosemide | Lasix, Apo-Furosemide, Oedemid, Urex Forte, Furosemid Stada |
| Bumetanide | Burinex |
| Amiloride | Kaluril |
| Eplerenone | Inspra, Eplerenone Te Arai |
| Spironolactone | Spiractin, Spirotone |
| Combination medicines that include diuretics | Frumil, Moduretic, Karvezide, Arrow-Losartan & Hydrochlorothiazide, Entresto |
- If you take blood pressure medicines, you should avoid anti-inflammatories.
- If you want to take anti-inflammatory medicines, check with your doctor or pharmacist first.
- Only take one type of anti-inflammatory medicine at a time.
- Take anti-inflammatories sparingly – take the smallest dose you need for the shortest possible time.
- Do not exceed the recommended dose.
Read more about how to protect your kidneys.
The triple whammy(external link) SafeRx, Waitematā DHB, NZ
Resources
Avoiding anti-inflammatories when taking blood pressure medicines [PDF, 203 KB] University of Otago, NZ, 2021
5 questions to ask about your medications(external link) Health Quality and Safety Commission, NZ, 2019 English(external link), te reo Māori(external link)
Brochures
University of Otago, NZ, 2021
At home sick day advice
Health New Zealand | Te Whatu Ora, 2023
Medicines and side effects
Healthify He Puna Waiora, NZ, 2024
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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.
Reviewed by: Angela Lambie, Pharmacist, Auckland
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