Atenolol and Tenoxicam: 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
Tenoxicam
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.
Here's what's going on. Atenolol (Tenormin) is a beta-blocker that helps lower your blood pressure. Tenoxicam is an anti-inflammatory pain medicine (an NSAID). When you take an NSAID like this, it can cause your body to hold onto a bit more fluid and can blunt how well your blood pressure medicine works. So your atenolol may not control your blood pressure quite as well while you're on both.
The good news: this is very manageable. Your care team can simply keep an eye on your blood pressure and adjust things if needed. Please don't stop either medicine on your own. Just check in with your pharmacist or doctor.
Effect: Reduced antihypertensive efficacy of atenolol when combined with tenoxicam (an NSAID).
Mechanism: NSAIDs inhibit renal prostaglandin synthesis, promoting sodium/fluid retention and increased vascular tone, which antagonizes beta-blocker blood pressure control. This is a pharmacodynamic interaction, not a metabolic one (neither agent is a prodrug requiring activation here).
- Direction: Attenuated BP-lowering effect (reduces drug effect)
- Onset: Delayed
- Evidence: Probable; documented for several NSAIDs (ibuprofen, naproxen, indomethacin, piroxicam)
- Management: Monitor blood pressure with concomitant use; individualize antihypertensive dosing as needed. Consider that sulindac may antagonize less.
What happens
Reduced antihypertensive effect
Interaction Deep Dive
Using 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 daily), ibuprofen (over 400 mg daily), indomethacin (over 50 mg daily), naproxen (1000 mg daily), 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
What your care team may do:
- Check your blood pressure more closely when you use both medicines together, since the effect builds up over time rather than right away.
- Adjust and individualize your blood pressure medicine dose if your readings creep up.
- Consider a different pain reliever if your blood pressure becomes harder to control.
What you can do: Keep taking both exactly as prescribed. Mention any home blood pressure readings, new headaches, swelling, or weight gain to your pharmacist or doctor, and ask before adding any over-the-counter anti-inflammatory pain relievers.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) Hypertensive patients continuing their usual medications received either ibuprofen 400 mg orally every 8 hours, acetaminophen, or placebo. After the 3-week trial concluded, those given ibuprofen demonstrated increases of about 6 mmHg across various blood pressure measures. Acetaminophen produced no demonstrable effect on blood pressure. The mechanism may relate to reduced effectiveness of antihypertensive agents due to interference with the production of vasodilator and natriuretic prostaglandins that these 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 investigated 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 left diastolic blood pressure unchanged. 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 two drugs together, suppressed plasma renin activity. When the two agents were combined, blood pressure fell (systolic: -5.9 mmHg; diastolic: -4 mmHg; mean: -4.6 mmHg), but these blood pressure changes were diminished by roughly 50% compared with those seen during the oxprenolol-alone period 7.
d) Simultaneous use of oral naproxen 500 mg twice daily or oral sulindac 200 mg twice daily produced no effect on blood pressure control in patients with mild to moderate hypertension managed with oral propranolol 10 mg to 240 mg daily in a single-blind study. 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 Tenoxicam together?
Tenoxicam can make atenolol work less well at controlling your blood pressure, so your team may monitor your readings and tailor your dose. Keep taking both as prescribed and check in with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atenolol and Tenoxicam 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 Tenoxicam interaction managed?
What your care team may do: Check your blood pressure more closely when you use both medicines together, since the effect builds up over time rather than right away. Adjust and individualize your blood pressure medicine dose if your readings creep up. Consider a different pain reliever if your blood pressure becomes harder to control. What you can do: Keep taking both exactly as prescribed. Mentio… 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 Tenoxicam 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 Tenoxicam
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