Atenolol and Sulindac: 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
Sulindac
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.
What's going on: Atenolol (Tenormin) is a beta-blocker used to lower blood pressure. Sulindac (Clinoril) is an anti-inflammatory pain reliever. Anti-inflammatory drugs like this can make the body hold onto a little more fluid and can blunt how well blood pressure medicines work, so your blood pressure could creep up.
Here's the reassuring part: sulindac is thought to be gentler on the kidneys' prostaglandins than most other NSAIDs, so it may interfere less than drugs like ibuprofen or naproxen. Please keep taking both as prescribed, and let your care team check your blood pressure. They can easily adjust things if needed.
Effect: Possible reduction in atenolol's antihypertensive efficacy (moderate severity, delayed onset, probable evidence).
Mechanism: NSAID-mediated inhibition of renal prostaglandin synthesis promotes sodium/fluid retention and attenuates vasodilation, opposing beta-blocker BP control.
- Reduced effect reported with flurbiprofen, ibuprofen, indomethacin, naproxen, and piroxicam.
- Sulindac may not antagonize beta-blocker antihypertensive effects, owing to relatively limited effect on renal prostaglandins.
Management: Monitor blood pressure during concomitant use. Antihypertensive regimen may need individualized adjustment if BP rises. Neither agent is renally activated in a way that alters interpretation.
What happens
Reduced antihypertensive effect
Interaction Deep Dive
Taking NSAIDs together with beta-adrenergic blockers can raise blood pressure and hinder blood pressure management94. Such an effect has been documented with flurbiprofen (400 mg per day), ibuprofen (exceeding 400 mg per day), indomethacin (exceeding 50 mg per day), naproxen (1000 mg per day), and piroxicam6510. In contrast, sulindac may not counteract the antihypertensive action of beta-blockers1110. Blood pressure should be monitored whenever NSAIDs and beta blockers must be used together14.
Why it happens (mechanism)
Decreased production of renal prostaglandins
How to manage this interaction
Keep taking both medicines as prescribed unless your prescriber tells you otherwise.
- Your care team will likely monitor your blood pressure more closely while you use these together.
- If your blood pressure rises, your atenolol or overall regimen may be adjusted and individualized by your care team.
- Home blood pressure readings can help; share them with your pharmacist or doctor.
- Ask your pharmacist before adding any other pain or anti-inflammatory product, since some interfere more than sulindac.
This is manageable with routine monitoring and small tailoring if needed.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) Hypertensive patients who were taking their regular medications received ibuprofen 400 mg orally every 8 hours, acetaminophen, or placebo. When the 3-week trial concluded, those given ibuprofen exhibited rises of roughly 6 mmHg across various blood pressure readings. Acetaminophen produced no measurable change in blood pressure. The mechanism may involve a reduction in the effectiveness of antihypertensive drugs due to interference with the generation of vasodilator and natriuretic prostaglandins that these antihypertensive agents stimulate. A decrease in 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 managed 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 did not change diastolic blood pressure. Sulindac 200 mg twice daily for 1 week affected neither blood pressure measure 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. When both drugs were administered together, blood pressure fell (systolic: -5.9 mmHg; diastolic: -4 mmHg; mean: -4.6 mmHg), but these blood pressure changes were diminished by about 50% relative to those seen 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 existing renal disease, heart failure, or cirrhosis were not included 8.
Common questions
Can I take Atenolol and Sulindac together?
Sulindac may slightly reduce how well atenolol controls your blood pressure, though it tends to interfere less than other NSAIDs. Keep taking both, and let your care team check your blood pressure so they can adjust if needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atenolol and Sulindac 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 Sulindac interaction managed?
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. Your care team will likely monitor your blood pressure more closely while you use these together. If your blood pressure rises, your atenolol or overall regimen may be adjusted and individualized by your care team. Home blood pressure readings can help; share them with your pharmacist or doctor. Ask your pharmacis… 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 Sulindac 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 Sulindac
Keep reading about Atenolol
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