Diflunisal 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
Diflunisal
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.
Here's the short version: Diflunisal (Dolobid) is an anti-inflammatory pain reliever, and atenolol (Tenormin) is a blood pressure medicine. When you take them together, the diflunisal can make the atenolol work a little less well, so your blood pressure may not be as well controlled as usual.
This happens because NSAIDs like diflunisal can cause your body to hold on to fluid and affect how your kidneys help regulate blood pressure. The good news is this is very manageable. Your care team can simply keep a closer eye on your blood pressure and adjust things if needed. Please don't stop either medicine on your own, just let your pharmacist or doctor know you're taking both.
Effect: NSAID (diflunisal) may attenuate the antihypertensive efficacy of atenolol.
Mechanism: Inhibition of renal prostaglandin synthesis reduces vasodilation and promotes sodium/fluid retention, blunting beta-blocker BP control. Neither agent requires bioactivation relevant here.
- Direction: Reduced antihypertensive (PD) effect of atenolol.
- Onset: Delayed.
- Evidence: Probable (class effect documented for several NSAIDs; sulindac may be less antagonistic).
- Management: Monitor blood pressure with concomitant use. Antihypertensive regimen may need to be adjusted and individualized. Consider agents with lesser renal PG impact if BP control is lost.
What happens
Reduced antihypertensive effect
Interaction Deep Dive
Taking NSAIDs together with beta-adrenergic blockers can raise blood pressure and hinder its control94. This 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 piroxicam 6510. In contrast, sulindac may not counteract the antihypertensive action of beta-blockers 1110. When NSAIDs and beta blockers must be used concurrently, monitor blood pressure 14.
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 while you use both medicines together.
- Adjust and individualize your blood pressure treatment if your numbers start creeping up.
- Possibly reconsider the pain medicine choice if blood pressure control becomes a problem.
What you can do:
- Keep taking both medicines exactly as prescribed unless told otherwise.
- Monitor your blood pressure at home if your team recommends it, and share the readings.
- Tell your pharmacist or doctor you take both, and ask about the safest pain relief option for you.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) Hypertensive patients maintained on their usual medications received either ibuprofen 400 mg orally every 8 hours, acetaminophen, or placebo. By the conclusion of the 3-week study, those given ibuprofen exhibited rises of about 6 mmHg across various blood pressure readings. Acetaminophen produced no measurable effect on blood pressure. The underlying mechanism may involve a reduction in the efficacy of antihypertensive drugs due to interference with the production of vasodilator and natriuretic prostaglandins that these agents stimulate. Diminished sodium excretion may have contributed to worsening of 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 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 given for 1 week did not modify either blood pressure measure 6.
c) The effects of indomethacin were assessed in 16 patients with essential hypertension who were treated with oxprenolol. Indomethacin and oxprenolol individually, as well as the combination of the two drugs, suppressed plasma renin activity. With the two agents administered together, blood pressure fell (systolic: -5.9 mmHg; diastolic: -4 mmHg; mean: -4.6 mmHg), but these blood pressure changes were diminished by roughly 50% relative to those observed during the oxprenolol-alone phase 7.
d) In a single-blind study, the concurrent use of oral naproxen 500 mg twice daily or oral sulindac 200 mg twice daily 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 Diflunisal and Atenolol together?
Diflunisal can make atenolol control your blood pressure a bit less effectively, so have your team monitor your blood pressure while you use both. Keep taking both as prescribed and report any rise in your readings. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Diflunisal 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 Diflunisal and Atenolol interaction managed?
What your care team may do: Check your blood pressure more closely while you use both medicines together. Adjust and individualize your blood pressure treatment if your numbers start creeping up. Possibly reconsider the pain medicine choice if blood pressure control becomes a problem. What you can do: Keep taking both medicines exactly as prescribed unless told otherwise. Monitor your blood pressu… 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 Diflunisal 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: 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 Diflunisal
Keep reading about Atenolol
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