Atenolol and Salsalate: 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
Salsalate
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.
Salsalate is a type of NSAID (a pain and anti-inflammatory medicine), and atenolol is a beta-blocker used to lower blood pressure. When you take them together, the salsalate can make the atenolol work a little less well, so your blood pressure may not be controlled as tightly as usual.
This happens because NSAIDs can lower certain substances in your kidneys (prostaglandins) that help keep blood pressure down. The good news is this is easy to manage. Don't stop either medicine on your own. Just let your doctor or pharmacist know you take both, and they can check your blood pressure and adjust things if needed.
Effect: Reduced antihypertensive efficacy of atenolol when combined with salsalate (an NSAID).
Mechanism: NSAID-mediated inhibition of renal prostaglandin synthesis promotes sodium/water retention and reduced vasodilation, blunting beta-blocker BP control. This is a PD interaction; neither agent's clearance is the driver.
- Direction: reduced atenolol antihypertensive effect (possible BP elevation)
- Onset: delayed
- Evidence: probable (class effect documented for several NSAIDs)
- Management: monitor blood pressure with concomitant use; individualize antihypertensive dosing as needed. Salsalate is a nonacetylated salicylate and may have a comparatively weaker prostaglandin effect, but monitoring is still advised.
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 may be disrupted94. This has been documented with flurbiprofen (400 mg daily), ibuprofen (in doses exceeding 400 mg daily), indomethacin (in doses above 50 mg daily), naproxen (1000 mg daily), and piroxicam6510. In contrast, sulindac may not counteract the antihypertensive action of beta-blockers1110. When NSAIDs and beta-blockers must be used together, blood pressure should be monitored14.
Why it happens (mechanism)
Decreased production of renal prostaglandins
How to manage this interaction
This interaction is manageable, and you should keep taking both medicines as prescribed unless your care team tells you otherwise.
- Your team may monitor your blood pressure more closely while you take both drugs, especially after starting or changing salsalate.
- Your blood pressure medicine dose may need to be adjusted and individualized by your care team if readings rise.
- Home blood pressure checks can help, if your provider recommends them.
- Tell your pharmacist or doctor about all pain relievers you use, including over-the-counter ones, since many are NSAIDs.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) Hypertensive patients taking their usual medications received ibuprofen 400 mg orally every 8 hours, acetaminophen, or placebo. After the 3-week trial concluded, patients who were given ibuprofen demonstrated increases of about 6 mmHg across several blood pressure measurements. Acetaminophen produced no detectable effect on blood pressure. The underlying mechanism may involve a reduction in the effectiveness of antihypertensive drugs due to interference with the production of vasodilator and natriuretic prostaglandins that antihypertensive agents stimulate. A decrease in sodium excretion may have contributed to worsening the hypertension 5.
b) The impact of naproxen and sulindac on blood pressure response was evaluated in 28 patients with mild to moderate essential hypertension that was well controlled by 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 did not change diastolic blood pressure. Sulindac 200 mg twice daily for 1 week altered neither blood pressure parameter 6.
c) The effects of indomethacin were assessed in 16 patients with essential hypertension being treated with oxprenolol. Indomethacin and oxprenolol individually, as well as the two drugs together, suppressed plasma renin activity. With the two drugs administered in combination, blood pressure fell (systolic: -5.9 mmHg; diastolic: -4 mmHg; mean: -4.6 mmHg), but the blood pressure changes produced were diminished by roughly 50% relative to those during the period of oxprenolol alone 7.
d) In a single-blind study, giving oral naproxen 500 mg twice daily or oral sulindac 200 mg twice daily concurrently 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 8.
Common questions
Can I take Atenolol and Salsalate together?
Salsalate can weaken atenolol's blood-pressure-lowering effect, so have your blood pressure watched and let your care team adjust your treatment if needed. Keep taking both unless your provider says otherwise. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atenolol and Salsalate 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 Salsalate interaction managed?
This interaction is manageable, and you should keep taking both medicines as prescribed unless your care team tells you otherwise. Your team may monitor your blood pressure more closely while you take both drugs, especially after starting or changing salsalate. Your blood pressure medicine dose may need to be adjusted and individualized by your care team if readings rise. Home blood pressure check… 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 Atenolol or Salsalate 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 Salsalate
Keep reading about Atenolol
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