Piketoprofen 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
Piketoprofen
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.
Piketoprofen is an anti-inflammatory (NSAID), and lisinopril is a blood pressure medicine. When you take them together, the NSAID can make your lisinopril work a little less well, so your blood pressure may creep up. The bigger concern is your kidneys. Both drugs affect blood flow through the kidneys, and used together they can strain them, especially if you are older, dehydrated, or already have kidney issues.
The good news is this is very manageable. Keep taking both as prescribed, drink plenty of fluids, and let your care team know you use both. They may check your blood pressure and run kidney blood tests to keep everything on track.
Mechanism: NSAIDs (piketoprofen) inhibit renal prostaglandin synthesis, reducing the vasodilatory and natriuretic effects that support ACE-inhibitor (lisinopril) efficacy. Neither agent is enzyme-mediated here; this is a pharmacodynamic interaction.
- Direction: reduced antihypertensive/natriuretic effect; additive renal risk (possible acute kidney injury).
- Evidence: established. Severity: moderate. Onset: unspecified.
- Management: assess need for renal monitoring at initiation, monitor BP for efficacy, and check renal function periodically. Higher risk in elderly, volume-depleted, or preexisting renal impairment. Ensure adequate hydration.
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 reduced by NSAIDs. Using these agents together may also worsen kidney function in certain patients, with acute renal failure being a potential outcome. If the combination cannot be avoided, evaluate whether renal function should be checked when therapy begins, watch for adequate antihypertensive control, and periodically test renal function to detect any decline or failure. This is particularly important in the elderly, at the start of treatment, in patients who are volume depleted, and in those with existing renal impairment. Confirm that patients maintain adequate hydration1234.
Why it happens (mechanism)
Additive effects on renal function; decreased renal prostaglandin production
How to manage this interaction
If both drugs are needed, they can be used together safely with attention from your care team.
- Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise.
- Stay well hydrated, which helps protect your kidneys.
- Your team may check your blood pressure to make sure your lisinopril is still working, and run kidney blood tests now and then, especially when starting out or if you are older or have kidney concerns.
- Tell your pharmacist or doctor about any swelling, much less urination, dizziness, or blood pressure that rises.
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 previously 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 the hypertension, so indomethacin was stopped. One day afterward, the patient underwent rapid diuresis and marked weight loss. The enalapril dose was subsequently lowered to 10 mg/day, achieving good hypertension control with no lingering psychosis 6.
b) In a randomized, double-blind, parallel-design multicenter study of 141 hypertensive patients, indomethacin counteracted the antihypertensive action of captopril. Combining indomethacin and captopril for one week raised 24-hour systolic blood pressure 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 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 had worsening hypertension after rofecoxib 25/day was started for arthritic pain. After 5 weeks, blood pressure rose from 130 to 135/80 to 85 to 168/98. Rofecoxib was discontinued. Blood pressure fell over the next 18 days (average, 127/78 mmHg). Rofecoxib was resumed at 25 mg/day because of increased joint pain. After 2 days of treatment, blood pressure rose, and over the following 2 weeks it averaged 143/89 mmHg. Lisinopril was raised to 20 mg/day, yielding an average blood pressure of 121/81 mmHg over the next 21 days 8.
d) In a double-blind, placebo-controlled, parallel-group trial involving 178 hypertensive patients, celecoxib did not diminish the antihypertensive effect of lisinopril. For 4 weeks, patients received either celecoxib 200 mg twice daily or placebo in addition to their usual lisinopril therapy (10 to 40 mg daily). The changes from baseline in 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 what has been reported for NSAIDs in ACE inhibitor-treated patients 9.
Common questions
Can I take Piketoprofen and Lisinopril together?
Piketoprofen (an NSAID) can weaken lisinopril's blood pressure effect and add strain on the kidneys, so stay hydrated 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 Piketoprofen 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 Piketoprofen and Lisinopril interaction managed?
If both drugs are needed, they can be used together safely with attention from your care team. Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise. Stay well hydrated, which helps protect your kidneys. Your team may check your blood pressure to make sure your lisinopril is still working, and run kidney blood tests now and then, especially when starting out or if you… 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 Piketoprofen 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
Keep reading about Lisinopril
Keep reading about Piketoprofen
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