Piroxicam 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
Atenolol
Piroxicam
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.
What's going on: Atenolol (Tenormin) is a beta-blocker that lowers your blood pressure. Piroxicam (Feldene) is an anti-inflammatory pain reliever (an NSAID). When taken together, piroxicam can make your body hold onto more fluid and can blunt how well the atenolol controls your blood pressure. In plain terms, your blood pressure may not come down as much as it should.
The good news is this is manageable. Your care team can keep an eye on your blood pressure and adjust things as needed. Please don't stop either medicine on your own. Just talk with your pharmacist or doctor so they can make a plan that works for you.
Effect: Reduced antihypertensive efficacy of atenolol when combined with piroxicam.
Mechanism: NSAID inhibition of renal prostaglandin synthesis promotes sodium/fluid retention and reduces vasodilation, antagonizing beta-blocker BP control. This is a PD interaction; neither drug requires the other for activation.
- Direction: Decreased atenolol antihypertensive response.
- Onset: Delayed.
- Evidence: Probable; documented for piroxicam and other NSAIDs.
- Management: Monitor blood pressure with concomitant use; antihypertensive regimen may need individualized adjustment. Sulindac may have less antagonistic effect if an NSAID alternative is considered.
What happens
Reduced antihypertensive effect
Interaction Deep Dive
Using NSAIDs together with beta-adrenergic blockers can raise blood pressure and disrupt blood pressure management94. Such an effect has been documented with flurbiprofen (400 mg per day), ibuprofen (exceeding 400 mg per day), indomethacin (exceeding 50 mg per day), naproxen (1000 mg per day), and piroxicam6510. In contrast, sulindac may not counteract the antihypertensive action of beta-blockers1110. When NSAIDs and beta blockers must be used concurrently, blood pressure should be monitored14.
Why it happens (mechanism)
Decreased production of renal prostaglandins
How to manage this interaction
If you need both medicines, your care team can manage this safely.
- Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise.
- Expect closer blood pressure monitoring. Your team may check it more often, and home readings can help.
- Your blood pressure treatment may be adjusted and individualized by your care team if readings run higher than target.
- Ask about pain options. Some pain relievers interfere less with blood pressure, so it's worth discussing alternatives if you use piroxicam regularly.
Share your home blood pressure numbers with your pharmacist or prescriber so they can fine-tune your plan.
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 were given ibuprofen 400 mg orally every 8 hours, acetaminophen, or placebo. When the 3-week study concluded, patients receiving ibuprofen exhibited rises of about 6 mmHg across several blood pressure measurements. Acetaminophen produced no detectable change in blood pressure. The underlying mechanism may involve reduced effectiveness of antihypertensive drugs due to interference with the production of vasodilator and natriuretic prostaglandins that 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 controlled by atenolol. Findings from this 5-week, double-blind, placebo-controlled trial showed that 1 week of naproxen 500 mg twice daily significantly raised systolic blood pressure (mean 4 mmHg) but left diastolic blood pressure unchanged. Sulindac 200 mg twice daily for 1 week changed neither blood pressure parameter 6.
c) The effects of indomethacin were assessed in 16 patients with essential hypertension who were being treated with oxprenolol. Indomethacin and oxprenolol individually, and the two combined, all 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 reductions were lessened by roughly 50% compared with the oxprenolol-alone phase 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 controlled 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 8.
Common questions
Can I take Piroxicam and Atenolol together?
Piroxicam can weaken how well atenolol controls your blood pressure, so have your blood pressure watched more closely and talk with your care team about the best plan. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Piroxicam 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 Piroxicam and Atenolol interaction managed?
If you need both medicines, your care team can manage this safely. Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise. Expect closer blood pressure monitoring. Your team may check it more often, and home readings can help. Your blood pressure treatment may be adjusted and individualized by your care team if readings run higher than target. Ask about pain options. S… 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 Piroxicam 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 Atenolol
Keep reading about Piroxicam
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