Nimesulide Beta Cyclodextrin and Lisinopril: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Lisinopril
Nimesulide Beta Cyclodextrin
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.
Lisinopril lowers your blood pressure, and it partly works by relying on natural substances in your kidneys called prostaglandins. Nimesulide is an anti-inflammatory pain reliever (an NSAID), and NSAIDs lower those same prostaglandins. When you take them together, your lisinopril may not control your blood pressure as well, and the combination can put extra stress on your kidneys.
The good news is that this is very manageable. Your care team can check your blood pressure and run simple kidney blood tests to make sure everything stays on track. Please don't stop either medicine on your own. Just talk with your pharmacist or doctor, and staying well hydrated helps too.
Interaction: NSAID (nimesulide) plus ACE inhibitor (lisinopril). Established evidence, moderate severity.
Mechanism: NSAID inhibition of renal prostaglandin synthesis reduces afferent arteriolar vasodilation and natriuresis, blunting the antihypertensive/natriuretic effect of lisinopril and producing additive risk of renal impairment, including possible acute renal failure.
- Direction: reduced antihypertensive efficacy; increased BP; potential decline in renal function.
- Higher risk: elderly, volume-depleted, preexisting renal dysfunction, treatment initiation.
- Management: monitor BP for efficacy; assess renal function at initiation and periodically; ensure adequate hydration; individualize therapy.
What happens
Reduced antihypertensive effect and renal dysfunction and/or increased blood pressure
Interaction Deep Dive
The natriuretic and blood pressure lowering actions of ACE inhibitors or angiotensin receptor blockers (ARBs) can be blunted by NSAIDs. Combining these agents may also worsen renal function in certain patients, potentially producing acute renal failure. If the two must be used together, evaluate whether renal function should be checked when therapy begins, watch for adequate antihypertensive response, and periodically reassess renal function for indications of decline or failure, particularly in elderly patients, at the start of therapy, in individuals who are volume-depleted, or in those with existing renal impairment. Confirm that patients maintain sufficient hydration1234.
Why it happens (mechanism)
Additive effects on renal function; decreased renal prostaglandin production
How to manage this interaction
If you have been prescribed both, keep taking them as directed unless your prescriber tells you otherwise. Here is what a care team typically does:
- Monitors your blood pressure to confirm the lisinopril is still working well.
- Checks kidney function with blood tests when starting and periodically after, especially if you are older, dehydrated, or already have kidney issues.
- Encourages good hydration.
- May adjust and individualize your doses or consider a different pain option if needed.
Tell your pharmacist or doctor if your blood pressure rises, or if you notice swelling, reduced urination, or unusual tiredness.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) A 48-year-old man with hypertension that had been well-controlled on enalapril 10 mg/day developed severe hypertension, psychosis, disorientation, and generalized anasarca four days after starting indomethacin 100 mg/day for gout 5. Raising the enalapril dose to 20 mg/day did not control his hypertension, and indomethacin was stopped. The following day, the patient underwent rapid diuresis and lost a substantial amount of weight. The enalapril dose was subsequently lowered back to 10 mg/day, achieving good hypertension control with no lasting psychosis 6.
b) In a randomized, double-blind, parallel-design multicenter study of 141 hypertensive patients, indomethacin opposed the antihypertensive action of captopril. After one week of taking indomethacin together with captopril, 24-hour systolic blood pressure rose by 4.6 mmHg and diastolic by 2.7 mmHg (p less than 0.001). In total, ambulatory diastolic blood pressure increased in 67% of the patients receiving captopril during indomethacin treatment 7.
c) A 59-year-old man who had been treated for 5 years with lisinopril 10 mg/day experienced worsening hypertension after rofecoxib 25/day was started for arthritic pain. Over 5 weeks, blood pressure rose from 130 to 135/80 to 85 up to 168/98. Rofecoxib was discontinued. Blood pressure fell over the next 18 days (average, 127/78 mmHg). Because of increased joint pain, rofecoxib was resumed at 25 mg/day. Two days into that therapy, blood pressure rose, and it averaged 143/89 mmHg over the following 2 weeks. Lisinopril was increased to 20 mg/day, which produced an average blood pressure of 121/81 mmHg over the next 21 days 8.
d) In a double-blind, placebo-controlled, parallel-group trial of 178 hypertensive patients, celecoxib did not diminish the antihypertensive effect of lisinopril. Patients were given celecoxib 200 mg twice daily or placebo in addition to their usual lisinopril regimen (10 to 40 mg daily) over 4 weeks. Changes from baseline in the 24-hour systolic and diastolic blood pressure (BP) were nonsignificant. The proportions of patients whose 24-hour BP rose by at least 5, 10, 15, or 20 mmHg were likewise comparable between celecoxib and placebo. The placebo-subtracted changes seen in 24-hour BP (1.6/1.2 mmHg) were smaller than those reported for NSAIDs in patients treated with ACE inhibitors 9.
Common questions
Can I take Nimesulide Beta Cyclodextrin and Lisinopril together?
Taking the NSAID nimesulide with lisinopril can weaken blood pressure control and stress your kidneys, so keep both as prescribed and let your care team monitor your blood pressure and kidney function. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Nimesulide Beta Cyclodextrin and Lisinopril interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Nimesulide Beta Cyclodextrin and Lisinopril interaction managed?
If you have been prescribed both, keep taking them as directed unless your prescriber tells you otherwise. Here is what a care team typically does: Monitors your blood pressure to confirm the lisinopril is still working well. Checks kidney function with blood tests when starting and periodically after, especially if you are older, dehydrated, or already have kidney issues. Encourages good hydratio… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Nimesulide Beta Cyclodextrin or Lisinopril 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 (9)
- Product Information: Dynastat intravenous injection, intramuscular injection, parecoxib sodium intravenous injection, intramuscular injection. Pfizer Australia Pty Ltd (per Australian Register of Therapeutic Goods), West Ryde, Australia, 2017. DailyMed
- Product Information: SPRIX(R) nasal spray, ketorolac tromethamine nasal spray. Egalet US Inc. (per FDA), Wayne, PA, 2016. DailyMed
- Product Information: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 2016. DailyMed
- Product Information: meloxicam oral tablets, meloxicam oral tablets. Apotex Corp. (per DailyMed), Weston, FL, 2016. DailyMed
- Ahmad S: Indomethacin-enalapril interaction: an alert (letter). South Med J 1991; 84:411-412. PubMed
- Morgan T, Anderson A, & Bertram D: Effect of indomethacin on blood pressure in elderly people with essential hypertension well controlled on amlodipine or enalapril. Am J Hypertens 2000; 13:1161-1167. PubMed
- Conlin P, Moore T, Swartz S, et al: Effect of indomethacin on blood pressure lowering by captopril and losartan in hypertensive patients. Hypertension 2000; 36:461-465. PubMed
- Brown C: Effect of rofecoxib on the antihypertensive activity of lisinopril (letter). Ann Pharmacother 2000; 34:1486. PubMed
- White W, Kent J, Taylor A, et al: Effects of celecoxib on ambulatory blood pressure in hypertensive patients on ACE inhibitors. Hypertension 2002; 39:929-934. PubMed
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