Acemetacin and Lisinopril: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lisinopril
Acemetacin
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Lisinopril lowers your blood pressure, and acemetacin is an anti-inflammatory pain reliever (an NSAID). When you take them together, the acemetacin can work against your lisinopril, making it less able to control your blood pressure. Both drugs also affect the kidneys, and using them together can put extra strain on them, especially if you are older, dehydrated, or already have kidney trouble.
The good news is this is very manageable. Please don't stop either medicine on your own. Just let your doctor or pharmacist know you take both so they can check your blood pressure and kidneys and keep an eye on things. Staying well hydrated also helps.
Effect: NSAID (acemetacin) may reduce the antihypertensive and natriuretic effect of the ACE inhibitor (lisinopril) and cause additive renal impairment, including possible acute renal failure.
Mechanism: Acemetacin inhibits renal prostaglandin synthesis, reducing afferent arteriolar vasodilation; combined with ACE inhibitor efferent effects, this compromises glomerular perfusion. Neither is a prodrug relevant here.
- Direction: reduced lisinopril efficacy; increased nephrotoxic risk.
- Evidence: established; onset: unspecified.
- Monitor: renal function (SCr, eGFR) at initiation and periodically, BP for efficacy. Highest risk in elderly, volume-depleted, or preexisting renal dysfunction. Ensure adequate hydration.
What happens
Reduced antihypertensive effect and renal dysfunction and/or increased blood pressure
Interaction Deep Dive
The blood pressure lowering and natriuretic actions of ACE inhibitors or angiotensin receptor blockers (ARBs) can be diminished by NSAIDs. Their combined use may also cause worsening renal function in certain patients, up to and including acute renal failure. If these agents must be given together, evaluate whether renal function monitoring is warranted when therapy begins, watch for adequate antihypertensive response, and check renal function at intervals to detect any decline or failure, particularly in elderly patients, at the start of treatment, in those who are volume-depleted, or in individuals with preexisting renal impairment. Confirm that patients are sufficiently hydrated1234.
Why it happens (mechanism)
Additive effects on renal function; decreased renal prostaglandin production
How to manage this interaction
This combination is commonly manageable when your care team is aware of it. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise.
- Your team may monitor your kidney function (blood tests) when starting and then periodically.
- They may check your blood pressure more closely to be sure the lisinopril is still working well.
- Stay well hydrated, which helps protect your kidneys.
- Tell your pharmacist or doctor if you are elderly, dehydrated, or have kidney problems, since extra caution helps.
Report reduced urine output, swelling, or unusually high blood pressure readings to your care team.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) A 48-year-old man with hypertension that had previously been well-managed on enalapril 10 mg/day developed severe hypertension, psychosis, disorientation, and generalized anasarca four days after beginning indomethacin 100 mg/day for gout 5. Raising the enalapril dose to 20 mg/day did not bring the hypertension under control, and indomethacin was stopped. Within one day, the patient underwent rapid diuresis and notable weight loss. The enalapril dose was subsequently lowered back to 10 mg/day, achieving good hypertension control with no lingering psychosis 6.
b) In a randomized, double-blind, parallel-design multicenter study of 141 hypertensive patients, indomethacin counteracted the antihypertensive action of captopril. After one week of combined indomethacin and captopril therapy, 24-hour systolic blood pressure rose by 4.6 mmHg and diastolic by 2.7 mmHg (p less than 0.001). In total, ambulatory diastolic blood pressure increased in 67% of patients receiving captopril while on indomethacin 7.
c) A 59-year-old man who had been treated for 5 years with lisinopril 10 mg/day experienced worsening hypertension after rofecoxib 25/day was started for arthritic pain. Over 5 weeks, blood pressure rose from 130 to 135/80 to 85 up to 168/98. Rofecoxib was withdrawn. Blood pressure decreased over the next 18 days (average, 127/78 mmHg). Because of increased joint pain, rofecoxib was resumed at 25 mg/day. After 2 days of this therapy, blood pressure rose, and over the following 2 weeks it averaged 143/89 mmHg. Lisinopril was increased to 20 mg/day, yielding an average blood pressure of 121/81 mmHg over the next 21 days 8.
d) In a double-blind, placebo-controlled, parallel-group trial involving 178 hypertensive patients, celecoxib did not diminish the antihypertensive effect of lisinopril. Patients received either celecoxib 200 mg twice daily or placebo in addition to their usual lisinopril regimen (10 to 40 mg daily) for 4 weeks. Changes from baseline in 24-hour systolic and diastolic blood pressure (BP) were nonsignificant. The proportions of patients whose 24-hour BP rose by at least 5, 10, 15, or 20 mmHg were likewise comparable between celecoxib and placebo. The placebo-subtracted changes seen in 24-hour BP (1.6/1.2 mmHg) were smaller than what has been reported for NSAIDs in patients treated with ACE inhibitors 9.
Common questions
Can I take Acemetacin and Lisinopril together?
Acemetacin can weaken lisinopril's blood pressure control and stress the kidneys, so keep taking both as prescribed and ask your care team to monitor your blood pressure and kidney function, and stay well hydrated. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acemetacin and Lisinopril interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Acemetacin and Lisinopril interaction managed?
This combination is commonly manageable when your care team is aware of it. Keep taking both medicines exactly as prescribed unless your prescriber tells you otherwise. Your team may monitor your kidney function (blood tests) when starting and then periodically. They may check your blood pressure more closely to be sure the lisinopril is still working well. Stay well hydrated, which helps protect… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Acemetacin or Lisinopril need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (9)
- Product Information: Dynastat intravenous injection, intramuscular injection, parecoxib sodium intravenous injection, intramuscular injection. Pfizer Australia Pty Ltd (per Australian Register of Therapeutic Goods), West Ryde, Australia, 2017. DailyMed
- Product Information: SPRIX(R) nasal spray, ketorolac tromethamine nasal spray. Egalet US Inc. (per FDA), Wayne, PA, 2016. DailyMed
- Product Information: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 2016. DailyMed
- Product Information: meloxicam oral tablets, meloxicam oral tablets. Apotex Corp. (per DailyMed), Weston, FL, 2016. DailyMed
- Ahmad S: Indomethacin-enalapril interaction: an alert (letter). South Med J 1991; 84:411-412. PubMed
- Morgan T, 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; 13:1161-1167. PubMed
- Conlin P, Moore T, Swartz S, et al: Effect of indomethacin on blood pressure lowering by captopril and losartan in hypertensive patients. Hypertension 2000; 36:461-465. PubMed
- Brown C: Effect of rofecoxib on the antihypertensive activity of lisinopril (letter). Ann Pharmacother 2000; 34:1486. PubMed
- White W, Kent J, Taylor A, et al: Effects of celecoxib on ambulatory blood pressure in hypertensive patients on ACE inhibitors. Hypertension 2002; 39:929-934. PubMed
Keep reading about Lisinopril
Keep reading about Acemetacin
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