Indomethacin 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
Indomethacin
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.
You're taking atenolol (Tenormin) to help control your blood pressure, and indomethacin (Indocin) for pain or inflammation. Here's the thing to know: indomethacin can partly work against your blood pressure medicine, making it a little less effective. That's because it lowers certain natural substances in your kidneys (called prostaglandins) that help keep blood pressure down. This tends to show up over time, not right away.
The good news is this is easy to keep an eye on. Don't stop or change either medicine on your own. Just let your doctor or pharmacist know you take both, and they may check your blood pressure more often to make sure it stays where they want it.
Effect: Indomethacin may attenuate the antihypertensive efficacy of atenolol, raising blood pressure.
Mechanism: NSAID inhibition of renal prostaglandin synthesis promotes sodium/fluid retention and blunts the beta-blocker's BP-lowering effect. This is a pharmacodynamic interaction, not enzymatic; neither agent is a prodrug.
- Direction: reduced atenolol antihypertensive effect
- Onset: delayed
- Evidence: probable; reported with indomethacin >50 mg/day
- Magnitude: variable, often modest
Management: Monitor blood pressure during concomitant use. Individualize antihypertensive dosing as needed; consider limiting NSAID dose/duration or an alternative analgesic if BP control is lost.
What happens
Reduced antihypertensive effect
Interaction Deep Dive
Using NSAIDs together with beta-adrenergic blocking agents can raise blood pressure and hinder its management94. 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 piroxicam6510. In contrast, sulindac may not oppose the antihypertensive action of beta-blockers1110. When NSAIDs and beta blockers must be given concurrently, blood pressure should be monitored14.
Why it happens (mechanism)
Decreased production of renal prostaglandins
How to manage this interaction
This interaction is manageable, and your care team has clear ways to handle it.
- Keep taking both exactly as prescribed unless your doctor tells you otherwise.
- Your team may monitor your blood pressure more closely while you use both drugs, especially since the effect builds up over time.
- Your blood pressure medicine dose may need to be adjusted and individualized by your care team if readings creep up.
- If you use indomethacin only occasionally or short term, the effect is usually smaller. Ask your pharmacist whether a different pain option might suit you better.
Let your pharmacist or prescriber know you take both so they can keep your blood pressure on target.
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, those given ibuprofen exhibited rises of about 6 mmHg across various blood pressure measurements. No detectable blood pressure effect was observed with acetaminophen. 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. A decrease in sodium excretion may have contributed to worsening 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 by atenolol. Findings from the 5-week, double-blind, placebo-controlled trial showed that 1 week of naproxen 500 mg twice daily produced a significant increase in systolic blood pressure (mean 4 mmHg) but did not change diastolic blood pressure. Sulindac 200 mg twice daily for 1 week did not alter either blood pressure parameter 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 two drugs together, suppressed plasma renin activity. With the combination, blood pressure fell (systolic: -5.9 mmHg; diastolic: -4 mmHg; mean: -4.6 mmHg), but these blood pressure changes were reduced by roughly 50% compared with the period of oxprenolol alone 7.
d) 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 controlled with oral propranolol 10 mg to 240 mg daily in a single-blind study. Serum propranolol levels were not measured, and patients with preexisting renal disease, heart failure, or cirrhosis were not included 8.
Common questions
Can I take Indomethacin and Atenolol together?
Indomethacin can make atenolol a bit less effective at controlling blood pressure over time, so keep taking both as prescribed and have your blood pressure checked more often. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Indomethacin 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 Indomethacin and Atenolol interaction managed?
This interaction is manageable, and your care team has clear ways to handle it. Keep taking both exactly as prescribed unless your doctor tells you otherwise. Your team may monitor your blood pressure more closely while you use both drugs, especially since the effect builds up over time. Your blood pressure medicine dose may need to be adjusted and individualized by your care team if readings cree… 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 Indomethacin 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 Indomethacin
Keep reading about Atenolol
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