Drug Interaction Report

Tolmetin and Atenolol: Interaction Details

A pharmacist-reviewed analysis of the Tolmetin and Atenolol interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · AI content regenerated Jul 15, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Tolmetin

Tolectin 600 Tolectin DS Tolectin® Tolectin® DS
+

Atenolol

Tenormin Tenormin®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Jul 11, 2026
Editorial policy · Data sources
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Interaction severity
Moderate
Can be significant — usually manageable with monitoring.
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.

Of 91 documented Tolmetin interactions, 28 are rated moderate — including this one.
At a glance + Effects may be weaker
The Bottom Line
Tolmetin can make atenolol control your blood pressure a bit less well, so keep taking both as prescribed and have your blood pressure watched more closely.

Here's what's going on: Tolmetin is an anti-inflammatory pain reliever (an NSAID), and atenolol is a beta-blocker you likely take to control your blood pressure. When you use them together, the tolmetin can make the atenolol work a little less well, so your blood pressure may creep up.

This happens because NSAIDs like tolmetin lower certain natural chemicals in your kidneys (prostaglandins) that help keep blood pressure down. The good news is this is very manageable. Keep taking both as prescribed, and let your doctor or pharmacist know you're on both so they can keep an eye on your blood pressure and adjust things if needed.

Effect: NSAID (tolmetin) may attenuate the antihypertensive efficacy of atenolol.

Mechanism: Tolmetin inhibits renal prostaglandin synthesis, reducing vasodilation and promoting sodium/water retention, which blunts beta-blocker BP control. This is a pharmacodynamic interaction (neither drug is a prodrug).

  • Direction: reduced atenolol antihypertensive effect
  • Onset: delayed
  • Evidence: probable; documented for several NSAIDs as a class effect
  • Severity: moderate

Management: Monitor blood pressure when coadministration is required. Antihypertensive regimen may need individualized adjustment; consider closer follow-up during initiation or dose changes.

Onset
delayed
Evidence
probable
Severity
Moderate

What happens

Reduced antihypertensive effect

Interaction Deep Dive

Using NSAIDs together with beta-adrenergic blockers can raise blood pressure and undermine blood pressure control94. This has been documented with flurbiprofen (400 mg daily), ibuprofen (greater than 400 mg daily), indomethacin (greater than 50 mg daily), naproxen (1000 mg daily), and piroxicam6510. In contrast, sulindac may not counteract the antihypertensive action of beta-blockers1110. When NSAIDs and beta blockers must be given concurrently, monitor blood pressure14.

Why it happens (mechanism)

Decreased production of renal prostaglandins

How to manage this interaction

The reassuring part: this is a well-understood interaction your care team can manage.

  • Keep taking both tolmetin and atenolol exactly as prescribed unless your doctor tells you otherwise.
  • Expect closer blood pressure checks when you start or change either medicine. Home monitoring may be suggested.
  • Your blood pressure dose may need to be adjusted and individualized by your care team if numbers rise.
  • Tell your pharmacist or prescriber you take both, and mention any new headaches, swelling, or higher readings.

Management is individual — confirm any change with your pharmacist or prescriber.

Literature reports

4 reports — tap to read

a) Hypertensive patients continuing their usual medications received ibuprofen 400 mg orally every 8 hours, acetaminophen, or placebo. After the 3-week trial concluded, those given ibuprofen exhibited rises of about 6 mmHg across various 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 generation of vasodilator and natriuretic prostaglandins that these agents stimulate. Diminished sodium excretion may have contributed to worsening the hypertension 5.

b) How naproxen and sulindac affect blood pressure response was investigated 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 produced a significant rise in 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 actions of indomethacin were assessed in 16 patients with essential hypertension being treated with oxprenolol. Indomethacin and oxprenolol individually, as well as the two agents together, suppressed plasma renin activity. With the two drugs combined, blood pressure fell (systolic: -5.9 mmHg; diastolic: -4 mmHg; mean: -4.6 mmHg), yet these blood pressure changes were roughly 50% smaller than those seen during the period of oxprenolol alone 7.

d) Giving oral naproxen 500 mg twice daily or oral sulindac 200 mg twice daily concurrently had no effect on blood pressure control in patients with mild to moderate hypertension managed with oral propranolol 10 mg to 240 mg daily in a single-blind study. Serum propranolol concentrations were not measured, and patients with existing renal disease, heart failure, or cirrhosis were not included 8.

Common questions

Can I take Tolmetin and Atenolol together?

Tolmetin can make atenolol control your blood pressure a bit less well, so keep taking both as prescribed and have your blood pressure watched more closely. Always confirm with your pharmacist or prescriber before making any change.

How serious is the Tolmetin 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 Tolmetin and Atenolol interaction managed?

The reassuring part: this is a well-understood interaction your care team can manage. Keep taking both tolmetin and atenolol exactly as prescribed unless your doctor tells you otherwise. Expect closer blood pressure checks when you start or change either medicine. Home monitoring may be suggested. Your blood pressure dose may need to be adjusted and individualized by your care team if numbers rise… 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 Tolmetin 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)

  1. Product Information: ZORVOLEX(R) oral capsules, diclofenac oral capsules. Iroko Pharmaceuticals, LLC (per FDA), Philadelphia, PA, 2016. DailyMed
  2. Product Information: ANAPROX(R) DS oral tablets, naproxen sodium oral tablets. Canton Laboratories, LLC (per FDA), Alpharetta, GA, 2016. DailyMed
  3. Product Information: CALDOLOR(R) intravenous injection, ibuprofen intravenous injection. Cumberland Pharmaceuticals Inc. (per FDA), Nashville, TN, 2016. DailyMed
  4. Product Information: COMBOGESIC(R) oral tablets, acetaminophen ibuprofen oral tablets. AFT Pharmaceuticals Inc (per FDA), Highland, MD, 2023. DailyMed
  5. 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
  6. 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
  7. 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
  8. 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
  9. Product Information: VIMOVO(TM) delayed release oral tablets, naproxen and esomeprazole magnesium delayed release oral tablets. AstraZeneca LPW, Wilmington, DE, 2010. DailyMed
  10. 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
  11. Abate MA, Neely JL, Layne RD, et al: Interaction of indomethacin and sulindac with labetolol. Br J Clin Pharmacol 1991; 31:363-366.
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