Atenolol and Diclofenac: 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
Atenolol
Diclofenac
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.
Atenolol (Tenormin) is a beta-blocker that helps lower your blood pressure. Diclofenac is an anti-inflammatory pain reliever (an NSAID). When you take them together, the diclofenac can make the atenolol work a little less well, so your blood pressure may not come down as much as it should.
This happens because NSAIDs lower the amount of certain natural substances (prostaglandins) your kidneys make to help control blood pressure. The good news is this is easy for your care team to handle. They can simply check your blood pressure and adjust your treatment if needed. Please don't stop either medicine on your own, just mention it to your pharmacist or doctor.
Effect: Diclofenac (NSAID) may blunt the antihypertensive efficacy of atenolol, a beta-blocker.
Mechanism: NSAID inhibition of renal prostaglandin synthesis reduces vasodilation and promotes sodium/fluid retention, opposing BP control. This is a PD interaction; neither agent's PK metabolism drives it.
- Direction: reduced antihypertensive effect
- Onset: delayed
- Evidence: probable (class effect documented for several NSAIDs)
- Magnitude: variable, dose-related
Management: Monitor blood pressure during concomitant use. Consider dose adjustment of the antihypertensive regimen, using the lowest effective NSAID dose for the shortest duration, and reassess as needed.
What happens
Reduced antihypertensive effect
Interaction Deep Dive
Using NSAIDs together with beta-adrenergic blockers can raise blood pressure and undermine blood pressure control94. Such an effect has been documented with flurbiprofen (400 mg per day), ibuprofen (above 400 mg per day), indomethacin (above 50 mg per day), naproxen (1000 mg per day), and piroxicam6510. In contrast, sulindac may not counteract the antihypertensive action of beta-blockers1110. When NSAIDs and beta blockers must be given concurrently, monitor blood pressure14.
Why it happens (mechanism)
Decreased production of renal prostaglandins
How to manage this interaction
This interaction is very manageable. Your care team will typically:
- Check your blood pressure more closely when you're using both medicines.
- Adjust and individualize your blood pressure treatment if readings creep up.
- Use the lowest effective dose of diclofenac for the shortest time needed.
What you should do: Keep taking both as prescribed unless your doctor tells you otherwise. Let your pharmacist or prescriber know you use both, and mention it if you notice higher home blood pressure readings, more swelling, or new headaches.
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 either ibuprofen 400 mg orally every 8 hours, acetaminophen, or placebo. When the 3-week trial concluded, those receiving ibuprofen exhibited increases of roughly 6 mmHg across various blood pressure measurements. Acetaminophen produced no measurable change in blood pressure. The proposed mechanism may relate to a reduction in the effectiveness of antihypertensive agents due to interference with the generation of vasodilator and natriuretic prostaglandins that these antihypertensive agents stimulate. Decreased sodium excretion may have contributed to worsening the hypertension 5.
b) The influence of naproxen and sulindac on blood pressure response was evaluated in 28 patients with mild to moderate essential hypertension that was well controlled with atenolol. Findings from the 5-week, double-blind, placebo-controlled trial 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 changed neither blood pressure parameter 6.
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 drugs, suppressed plasma renin activity. With the two drugs administered together, blood pressure fell (systolic: -5.9 mmHg; diastolic: -4 mmHg; mean: -4.6 mmHg); however, these blood pressure changes were diminished by approximately 50% relative to those observed during the oxprenolol-alone period 7.
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 preexisting renal disease, heart failure, or cirrhosis were not included in the study 8.
Common questions
Can I take Atenolol and Diclofenac together?
Diclofenac can make atenolol less effective at controlling your blood pressure, so your team may check your readings and adjust your treatment as needed. Keep taking both as prescribed and tell your pharmacist or doctor you use them together. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atenolol and Diclofenac 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 Atenolol and Diclofenac interaction managed?
This interaction is very manageable. Your care team will typically: Check your blood pressure more closely when you're using both medicines. Adjust and individualize your blood pressure treatment if readings creep up. Use the lowest effective dose of diclofenac for the shortest time needed. What you should do: Keep taking both as prescribed unless your doctor tells you otherwise. Let your pharmaci… 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Atenolol or Diclofenac 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: 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: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 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. DOI
- 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. PubMed
- Product Information: VIMOVO(TM) delayed release oral tablets, naproxen and esomeprazole magnesium delayed release oral tablets. AstraZeneca LPW, Wilmington, DE, 2010. DailyMed
- 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.
Keep reading about Atenolol
Keep reading about Diclofenac
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