Drug Interaction Report

Nimesulide Beta Cyclodextrin and Atenolol: Interaction Details

A pharmacist-reviewed analysis of the Nimesulide Beta Cyclodextrin and Atenolol interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

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

Tenormin Tenormin®
+

Nimesulide Beta Cyclodextrin

No brand names on record
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Jul 11, 2026
Editorial policy · Data sources
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Interaction severity
Moderate
Can be significant — usually manageable with monitoring.
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.

Of 91 documented Nimesulide Beta Cyclodextrin interactions, 28 are rated moderate — including this one.
At a glance + Effects may be weaker
The Bottom Line
Nimesulide can blunt how well atenolol controls your blood pressure, so keep taking both as prescribed and let your care team monitor your blood pressure, adjusting treatment if needed.

You're taking atenolol to help control your blood pressure. Nimesulide is an anti-inflammatory pain reliever (an NSAID). When these two are used together, the NSAID can make your blood pressure medicine work a little less well, so your blood pressure may creep up.

This happens because NSAIDs lower certain natural substances in your kidneys (called prostaglandins) that help keep your blood pressure down. The good news is this is very manageable. Please don't stop either medicine on your own. Just let your pharmacist or doctor know you take both, and they can check your blood pressure and adjust things if needed.

Effect: Reduced antihypertensive efficacy of atenolol when combined with the NSAID nimesulide.

Mechanism: NSAID-mediated inhibition of renal prostaglandin synthesis promotes sodium/fluid retention and reduced vasodilation, antagonizing beta-blocker blood pressure control (PD interaction; neither drug relies on the other for activation).

  • Direction: Attenuated BP-lowering effect (reduced drug effect).
  • Onset: Delayed.
  • Evidence: Probable; class effect documented with several NSAIDs.
  • Magnitude: Dose-related; more likely at higher/sustained NSAID doses.

Management: Monitor blood pressure when coadministration is required; individualize antihypertensive therapy. Consider that sulindac may be less antagonistic if an alternative is being weighed by the prescriber.

Onset
delayed
Evidence
probable
Severity
Moderate

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 per day), ibuprofen (over 400 mg per day), indomethacin (over 50 mg per day), naproxen (1000 mg per day), and piroxicam6510. In contrast, sulindac may not counteract the antihypertensive action of beta-blockers1110. Where NSAIDs and beta blockers must be given concurrently, monitoring of blood pressure is advised14.

Why it happens (mechanism)

Decreased production of renal prostaglandins

How to manage this interaction

This combination is commonly used and can be managed well by your care team.

  • Keep taking both medicines as prescribed unless your doctor or pharmacist tells you otherwise.
  • Expect closer blood pressure monitoring. Your team may check your readings more often, especially when you first start the NSAID or use it regularly.
  • Your blood pressure treatment may need to be adjusted and individualized by your care team if your numbers rise.
  • Tell your pharmacist or doctor if you'll be using the NSAID for more than a few days, or if you have a home BP monitor showing higher readings.

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 ibuprofen 400 mg orally every 8 hours, acetaminophen, or placebo. After the 3-week study concluded, those who received ibuprofen demonstrated rises of roughly 6 mmHg across several blood pressure measurements. Acetaminophen produced no observable change in blood pressure. The underlying 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 study showed that 1 week of naproxen 500 mg twice daily produced a significant rise in systolic blood pressure (mean 4 mmHg) but did not change diastolic blood pressure. Sulindac 200 mg twice daily for 1 week changed neither blood pressure measurement 6.

c) The effects of indomethacin were assessed in 16 patients with essential hypertension being treated with oxprenolol. Indomethacin and oxprenolol individually, along with the combination of the two drugs, suppressed plasma renin activity. When the two agents 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 roughly 50% relative to those seen during the period of oxprenolol alone 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 preexisting renal disease, heart failure, or cirrhosis were not included in the study 8.

Common questions

Can I take Nimesulide Beta Cyclodextrin and Atenolol together?

Nimesulide can blunt how well atenolol controls your blood pressure, so keep taking both as prescribed and let your care team monitor your blood pressure, adjusting treatment if needed. Always confirm with your pharmacist or prescriber before making any change.

How serious is the Nimesulide Beta Cyclodextrin 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 Nimesulide Beta Cyclodextrin and Atenolol interaction managed?

This combination is commonly used and can be managed well by your care team. Keep taking both medicines as prescribed unless your doctor or pharmacist tells you otherwise. Expect closer blood pressure monitoring. Your team may check your readings more often, especially when you first start the NSAID or use it regularly. Your blood pressure treatment may need to be adjusted and individualized by yo… 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 Nimesulide Beta Cyclodextrin 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)

  1. Product Information: ZORVOLEX(R) oral capsules, diclofenac oral capsules. Iroko Pharmaceuticals, LLC (per FDA), Philadelphia, PA, 2016. DailyMed
  2. Product Information: ANAPROX(R) DS oral tablets, naproxen sodium oral tablets. Canton Laboratories, LLC (per FDA), Alpharetta, GA, 2016. DailyMed
  3. Product Information: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 2016. DailyMed
  4. Product Information: COMBOGESIC(R) oral tablets, acetaminophen ibuprofen oral tablets. AFT Pharmaceuticals Inc (per FDA), Highland, MD, 2023. DailyMed
  5. 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
  6. 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
  7. 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
  8. 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
  9. Product Information: VIMOVO(TM) delayed release oral tablets, naproxen and esomeprazole magnesium delayed release oral tablets. AstraZeneca LPW, Wilmington, DE, 2010. DailyMed
  10. 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
  11. Abate MA, Neely JL, Layne RD, et al: Interaction of indomethacin and sulindac with labetolol. Br J Clin Pharmacol 1991; 31:363-366.
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