Indomethacin with Atenolol Interaction Details

Brand Names Associated with Indomethacin

  • Indocin®
  • Indomethacin
  • Tivorbex®

Brand Names Associated with Atenolol

  • Atenolol
  • Tenoretic® (as a combination product containing Atenolol and Chlorthalidone)
  • Tenormin®

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Last updated Mar 04, 2024

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Interaction Effect

Hypoglycemia or hyperglycemia; decreased symptoms of hypoglycemia

Interaction Summary

Concomitant antidiabetic drugs and beta-blockers may lead to hypo- or hyperglycemia, or may obscure symptoms of hypoglycemia[12][13]. Tachycardia, but not other symptoms of hypoglycemia, such as dizziness and sweating, may be affected [14]. Nonselective beta blockers can potentiate insulin-induced hypoglycemia and interfere with recovery of serum glucose levels. Worsening hyperglycemia may occur in patients with heart failure and diabetes [15]. Increased frequency of glucose monitoring or dose adjustment of the antidiabetic agent may be required [12][13]. Closely monitor for signs and symptoms of hypoglycemia with concurrent use, and if the beta-blocker is withdrawn, observe for loss of glycemic control [16].

Severity

Moderate

Onset

Delayed

Evidence

Probable

How To Manage Interaction

Concurrent use of antidiabetic agents with beta-blockers may increase or decrease the blood glucose lowering effect of the antidiabetic agent, and may decrease or obscure signs and symptoms of hypoglycemia. Increased frequency of glucose monitoring or dose adjustment of the antidiabetic agent may be required[12][13]. Closely monitor for hypoglycemia with concurrent use, and if the beta-blocker is withdrawn, observe for signs of loss of glycemic control [16].

Mechanism Of Interaction

Altered glucose metabolism and beta blockade

Literature Reports

A) The choice of antihypertensive drug in elderly patients with diabetes who were taking either insulin or sulfonylureas had little effect on the risk of hypoglycemia, but after adjustment for other risk factors, the lowest risk was with cardioselective beta blockers and the highest with non-cardioselective beta blockers, with other antihypertensive drugs having intermediate results (N=13,559) [17].

B) Beta blockers, but not alpha blockade and ACE inhibitors, caused a deterioration in long-term glycemic control in patients with hypertension and non-insulin dependent diabetes. Some adverse effects on the lipid profile also occurred with beta blockade. These effects were especially apparent with propranolol. Concurrent use of an alpha blocker with the beta blocker prevented the deterioration due to beta blockade [18].

References

    1 ) Product Information: VIMOVO(TM) delayed release oral tablets, naproxen and esomeprazole magnesium delayed release oral tablets. AstraZeneca LPW, Wilmington, DE, 2010.

    2 ) Product Information: COMBOGESIC(R) oral tablets, acetaminophen ibuprofen oral tablets. AFT Pharmaceuticals Inc (per FDA), Highland, MD, 2023.

    3 ) 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.

    4 ) 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.

    5 ) 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.

    6 ) Abate MA, Neely JL, Layne RD, et al: Interaction of indomethacin and sulindac with labetolol. Br J Clin Pharmacol 1991; 31:363-366.

    7 ) Product Information: ZORVOLEX(R) oral capsules, diclofenac oral capsules. Iroko Pharmaceuticals, LLC (per FDA), Philadelphia, PA, 2016.

    8 ) Product Information: ANAPROX(R) DS oral tablets, naproxen sodium oral tablets. Canton Laboratories, LLC (per FDA), Alpharetta, GA, 2016.

    9 ) Product Information: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 2016.

    10 ) 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.

    11 ) 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.

    12 ) Product Information: TOUJEO(R) subcutaneous injection, insulin glargine subcutaneous injection. sanofi-aventis (per manufacturer), Bridgewater, NJ, 2015.

    13 ) Product Information: AMARYL(R) oral tablets, glimepiride oral tablets . Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2013.

    14 ) Product Information: TENORMIN(R) oral tablets, atenolol oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2012.

    15 ) Product Information: COREG CR(R) extended-release oral capsules, carvedilol phosphate extended-release oral capsules. GlaxoSmithKline, Research Triangle Park, NC, 2011.

    16 ) Product Information: Glynase(R) PresTab(R) oral micronized tablets, glyburide oral micronized tablets. Pharmacia & Upjohn Co (per FDA), New York, NY, 2013.

    17 ) Shorr RI, Ray WA, Daugherty JR, et al: Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas. JAMA 1997; 278:40-43.

    18 ) Whitcroft IA, Thomas JM, Rawsthorne A, et al: Effects of alpha and beta adrenoceptor blocking drugs and ACE inhibitors on long term glucose and lipid control in hypertensive non-insulin dependent diabetics. Horm Metab Res Suppl 1990; 22:42-46.

Indomethacin Overview

  • Indomethacin is used to relieve moderate to severe pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints), rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), and ankylosing spondylitis (arthritis that mainly affects the spine). Indomethacin is also used to treat pain in the shoulder caused by bursitis (inflammation of a fluid-filled sac in the shoulder joint) and tendinitis (inflammation of the tissue that connects muscle to bone). Indomethacin immediate-release capsules and suspension (liquid) are also used to treat acute gouty arthritis (attacks of severe joint pain and swelling caused by a build-up of certain substances in the joints). Indomethacin is in a class of medications called NSAIDs. It works by stopping the body's production of a substance that causes pain, fever, and inflammation.

See More information Regarding Indomethacin

Atenolol Overview

  • Atenolol is used alone or in combination with other medications to treat high blood pressure. It also is used to prevent angina (chest pain) and improve survival after a heart attack. Atenolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

  • High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

See More information Regarding Atenolol

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.


Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.


Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.


Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.