Aspirin Rectal and Atenolol: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 15, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Aspirin Rectal
Atenolol
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.
Aspirin (even the rectal form) is an NSAID, and atenolol is a blood pressure medicine (a beta-blocker). When taken together, aspirin can make atenolol work a little less well, so your blood pressure may not drop as much as it should. This happens because aspirin lowers certain natural chemicals in your kidneys (prostaglandins) that help control blood pressure.
The good news is this is easy for your care team to handle. If you take both, your doctor or pharmacist can simply keep an eye on your blood pressure and adjust things if needed. Don't stop either medicine on your own, just bring it up at your next visit.
Effect: Reduced antihypertensive efficacy of atenolol when combined with aspirin (an NSAID).
Mechanism: NSAID inhibition of renal prostaglandin synthesis promotes sodium/water retention and blunts beta-blocker-mediated BP lowering. This is a PD interaction; neither agent's active form depends on the other.
Direction/magnitude: Attenuated BP control; magnitude documented for several NSAIDs, dose-related. Onset delayed; evidence probable.
- Monitor blood pressure during concomitant use.
- Atenolol dose may need to be individualized by the care team.
- Note sulindac may be less likely to antagonize beta-blockers.
What happens
Reduced antihypertensive effect
Interaction Deep Dive
When NSAIDs are given together with beta-adrenergic blockers, blood pressure may rise and control of blood pressure can be disrupted15. Such an outcome has been documented with flurbiprofen (400 mg per day), ibuprofen (greater than 400 mg per day), indomethacin (greater than 50 mg per day), naproxen (1000 mg per day), and piroxicam7610. In contrast, sulindac may not counteract the antihypertensive action of beta-blockers1110. Blood pressure should be monitored whenever combined use of NSAIDs and beta blockers is necessary35.
Why it happens (mechanism)
Decreased production of renal prostaglandins
How to manage this interaction
This is a manageable combination. Care teams typically:
- Monitor blood pressure more closely when aspirin and atenolol are used together.
- Adjust and individualize the atenolol dose if blood pressure control slips.
What you can do:
- Keep taking both exactly as prescribed unless told otherwise.
- Check your blood pressure at home if you have a monitor, and share the readings.
- Tell your pharmacist or doctor how much aspirin you take and how often, since higher, regular NSAID use matters more than occasional doses.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) Hypertensive patients on their usual medications received ibuprofen 400 mg orally every 8 hours, acetaminophen, or placebo. At the conclusion of the 3-week study, those given ibuprofen demonstrated rises of about 6 mmHg across various blood pressure measurements. Acetaminophen produced no detectable effect on blood pressure. The proposed mechanism may involve reduced effectiveness of antihypertensive drugs due to interference with the generation of vasodilator and natriuretic prostaglandins that antihypertensive agents stimulate. A decrease in sodium excretion may have contributed to worsening hypertension 6.
b) Naproxen and sulindac were evaluated for their impact on blood pressure response in 28 patients with mild to moderate essential hypertension that was well controlled with atenolol. Findings from the 5-week, double-blind, placebo-controlled study showed that 1 week of naproxen 500 mg twice daily significantly raised systolic blood pressure (mean 4 mmHg) but produced no change in diastolic blood pressure. Sulindac 200 mg twice daily for 1 week did not change either blood pressure measurement 7.
c) The effects of indomethacin were assessed in 16 patients with essential hypertension who were being treated with oxprenolol. Indomethacin and oxprenolol individually, as well as the combination of the two, suppressed plasma renin activity. With the two drugs given together, blood pressure fell (systolic: -5.9 mmHg; diastolic: -4 mmHg; mean: -4.6 mmHg), but these blood pressure changes were about 50% smaller than those observed during the oxprenolol-alone phase 8.
d) In a single-blind study, giving oral naproxen 500 mg twice daily or oral sulindac 200 mg twice daily at the same time had no effect on blood pressure control in patients with mild to moderate hypertension managed with oral propranolol 10 mg to 240 mg daily. Serum propranolol concentrations were not measured, and patients with existing renal disease, heart failure, or cirrhosis were not included in the study 9.
Common questions
Can I take Aspirin Rectal and Atenolol together?
Regular aspirin use can make atenolol control your blood pressure a bit less well, so have your care team monitor your blood pressure while you use both. Keep taking both as prescribed and raise it at your next visit. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Aspirin Rectal and Atenolol interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How is the Aspirin Rectal and Atenolol interaction managed?
This is a manageable combination. Care teams typically: Monitor blood pressure more closely when aspirin and atenolol are used together. Adjust and individualize the atenolol dose if blood pressure control slips. What you can do: Keep taking both exactly as prescribed unless told otherwise. Check your blood pressure at home if you have a monitor, and share the readings. Tell your pharmacist or doc… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Aspirin Rectal or Atenolol 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 (11)
- Product Information: VIMOVO(TM) delayed release oral tablets, naproxen and esomeprazole magnesium delayed release oral tablets. AstraZeneca LPW, Wilmington, DE, 2010. DailyMed
- Product Information: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 2016. DailyMed
- Product Information: ZORVOLEX(R) oral capsules, diclofenac oral capsules. Iroko Pharmaceuticals, LLC (per FDA), Philadelphia, PA, 2016. DailyMed
- Product Information: ANAPROX(R) DS oral tablets, naproxen sodium oral tablets. Canton Laboratories, LLC (per FDA), Alpharetta, GA, 2016. DailyMed
- Product Information: COMBOGESIC(R) oral tablets, acetaminophen ibuprofen oral tablets. AFT Pharmaceuticals Inc (per FDA), Highland, MD, 2023. DailyMed
- Radack KL, Deck CC, & Bloomfield SS: Ibuprofen interferes with the efficacy of antihypertensive drugs. A randomized, double-blind, placebo-controlled trial of ibuprofen compared with acetaminophen. Ann Intern Med 1987; 107:628-635. PubMed
- Abate MA, Layne RD, Neely JL, et al: Effect of naproxen and sulindac on blood pressure response to atenolol. Drug Intell Clin Pharm 1990; 24:810-813. DOI
- Salvetti A, Arzilli F, Pedrinelli R, et al: Interaction between oxprenolol and indomethacin on blood pressure in essential hypertensive patients. Eur J Clin Pharmacol 1982; 22:197-201. PubMed
- Schuna AA, Vejraska BD, Hiatt JG, et al: Lack of interaction between sulindac or naproxen and propranolol in hypertensive patients. J Clin Pharmacol 1989; 29:524-528. DOI
- Salvetti A, Pedrinelli R, Alberici P, et al: The influence of indomethacin and sulindac on some pharmacological actions of atenolol in hypertensive patients. Br J Clin Pharmacol 1984; 17(suppl):108S-111S. PubMed
- Abate MA, Neely JL, Layne RD, et al: Interaction of indomethacin and sulindac with labetolol. Br J Clin Pharmacol 1991; 31:363-366.
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