Rofecoxib 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
Rofecoxib
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.
You're taking atenolol to help lower your blood pressure, and rofecoxib is an anti-inflammatory medicine for pain. When these are used together, the rofecoxib can make the atenolol work a little less well, so your blood pressure may not stay as controlled as usual.
This happens because anti-inflammatory drugs can affect substances in your kidneys that help manage blood pressure and fluid. The good news is this is very manageable. Your care team can keep an eye on your blood pressure and adjust things if needed. Please don't stop either medicine on your own, just mention this to your pharmacist or doctor.
Effect: Reduced antihypertensive efficacy of atenolol when combined with rofecoxib (an NSAID/COX-2 inhibitor).
- Mechanism: NSAID-mediated inhibition of renal prostaglandin synthesis, promoting sodium/fluid retention and blunting beta-blocker BP control (PD interaction, not PK).
- Direction: Attenuates atenolol's effect (neither drug is a prodrug).
- Onset: Delayed. Evidence: Probable; documented for several NSAIDs, magnitude for rofecoxib not quantified.
- Management: Monitor blood pressure with concurrent use; the antihypertensive regimen may need individualized adjustment.
What happens
Reduced antihypertensive effect
Interaction Deep Dive
Taking NSAIDs together with beta-adrenergic blockers can raise blood pressure and disrupt blood pressure management94. This has been documented with flurbiprofen (400 mg per day), ibuprofen (in excess of 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 used together, monitor blood pressure14.
Why it happens (mechanism)
Decreased production of renal prostaglandins
How to manage this interaction
This interaction is manageable, and both medicines can usually be continued as prescribed.
- Keep taking both exactly as directed unless your prescriber tells you otherwise.
- Your care team will likely monitor your blood pressure more closely when these are used together.
- Your blood pressure medicine dose may need to be adjusted and individualized by your care team if readings rise.
- If you check your blood pressure at home, share the readings with your pharmacist or doctor.
- Ask your pharmacist before starting any new pain reliever, since some options may affect blood pressure less.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) Hypertensive patients taking their standard medications received ibuprofen 400 mg orally every 8 hours, acetaminophen, or placebo. When the 3-week study concluded, those assigned to ibuprofen exhibited rises of about 6 mmHg across various blood pressure measurements. Acetaminophen produced no measurable change in blood pressure. The underlying mechanism may involve a lessening of the effectiveness of antihypertensive drugs because of interference with the generation of vasodilator and natriuretic prostaglandins that these antihypertensive agents stimulate. Diminished 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 with atenolol. In this 5-week, double-blind, placebo-controlled trial, the findings showed that 1 week of naproxen 500 mg twice daily produced a significant rise in systolic blood pressure (mean 4 mmHg) but caused no change in diastolic blood pressure. Sulindac 200 mg twice daily for 1 week did not modify either blood pressure measurement 6.
c) The effects of indomethacin were assessed in 16 patients with essential hypertension who were being treated with oxprenolol. Indomethacin and oxprenolol individually, as well as the combination of the two drugs, suppressed plasma renin activity. With the combined regimen, blood pressure fell (systolic: -5.9 mmHg; diastolic: -4 mmHg; mean: -4.6 mmHg), but the blood pressure changes produced were diminished by roughly 50% compared with those seen during 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 by 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 Rofecoxib and Atenolol together?
Rofecoxib can make atenolol control your blood pressure a bit less effectively, so have your blood pressure watched and talk with your pharmacist or doctor rather than changing anything yourself. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Rofecoxib 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 Rofecoxib and Atenolol interaction managed?
This interaction is manageable, and both medicines can usually be continued as prescribed. Keep taking both exactly as directed unless your prescriber tells you otherwise. Your care team will likely monitor your blood pressure more closely when these are used together. Your blood pressure medicine dose may need to be adjusted and individualized by your care team if readings rise. If you check your… 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 Rofecoxib 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 Rofecoxib
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