Tenoxicam 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
Tenoxicam
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 tenoxicam is an anti-inflammatory pain reliever (an NSAID). When you take them together, the tenoxicam can make your lisinopril work less well, so your blood pressure may creep back up. Both drugs also affect the kidneys, so using them together can put extra strain on your kidneys, especially if you are older, dehydrated, or already have kidney trouble.
This is a well-known interaction, but it is very manageable. Please don't stop either medicine on your own. Talk with your pharmacist or doctor, and staying well hydrated and keeping up with your check-ups goes a long way.
Effect: NSAID (tenoxicam) reduces the antihypertensive and natriuretic effect of the ACE inhibitor (lisinopril) and can precipitate renal deterioration, including acute kidney injury.
Mechanism: Tenoxicam inhibits renal prostaglandin synthesis, blunting afferent arteriolar vasodilation; combined with ACE inhibitor efferent vasodilation, glomerular perfusion pressure falls (additive renal effects). Neither agent requires bioactivation for this PD interaction.
Evidence: Established. Onset: unspecified.
- Monitor BP for loss of efficacy.
- Check renal function at initiation and periodically.
- Higher risk: elderly, volume-depleted, preexisting renal impairment.
- Maintain adequate hydration; dose/therapy individualized by care team.
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 diminished by NSAIDs. Using these agents together may also cause renal function to worsen in certain patients, up to and including acute renal failure. If both drugs must be given at the same time, evaluate whether renal function monitoring is warranted when therapy begins, watch for adequate antihypertensive response, and periodically check renal function for indications of decline or failure, particularly among elderly patients, at the start of therapy, in those who are volume-depleted, or in individuals 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
This combination can be used when needed, and your care team can manage it safely.
- Keep taking both as prescribed unless your prescriber tells you otherwise.
- Your team may check your kidney function when you start and periodically after, and monitor your blood pressure to make sure the lisinopril is still working.
- Stay well hydrated, as fluid loss raises the risk.
- Tell your pharmacist or doctor if you are elderly, dehydrated, or have any kidney problems, since extra caution helps.
Report swelling, much less urine, unusual tiredness, or rising blood pressure readings to your care team.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
4 reports — tap to read
a) A 48-year-old hypertensive man whose blood pressure had previously been well managed 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 failed to control the hypertension, so indomethacin was stopped. One day afterward, the patient underwent rapid diuresis with substantial weight loss. The enalapril dose was subsequently lowered back 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 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 patients receiving captopril while on indomethacin 7.
c) A 59-year-old man who had been managed for 5 years on lisinopril 10 mg/day experienced worsening hypertension after starting rofecoxib 25/day 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 during the subsequent 18 days (average, 127/78 mmHg). Because of increased joint pain, rofecoxib was resumed at 25 mg/day. Following 2 days of this therapy, blood pressure rose, and over the ensuing 2 weeks it averaged 143/89 mmHg. Lisinopril was increased 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 of 178 hypertensive patients, celecoxib did not diminish the antihypertensive effect of lisinopril. Patients took celecoxib 200 mg twice daily or placebo along with 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 percentages 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 noted in 24-hour BP (1.6/1.2 mmHg) were smaller than what has been reported for NSAIDs in patients treated with ACE inhibitors 9.
Common questions
Can I take Tenoxicam and Lisinopril together?
Tenoxicam can weaken lisinopril's blood pressure control and strain your kidneys, so keep taking both as prescribed, 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 Tenoxicam 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 Tenoxicam and Lisinopril interaction managed?
This combination can be used when needed, and your care team can manage it safely. Keep taking both as prescribed unless your prescriber tells you otherwise. Your team may check your kidney function when you start and periodically after, and monitor your blood pressure to make sure the lisinopril is still working. Stay well hydrated, as fluid loss raises the risk. Tell your pharmacist or doctor if… 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 Tenoxicam 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 Tenoxicam
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