NSAIDs and blood pressure medicines

Also called triple whammy

Taking anti-inflammatories while you take some blood pressure medicines can damage your kidneys.

You should AVOID anti-inflammatories if you are taking:
  • ACE inhibitors (angiotensin converting enzyme inhibitors) AND diuretics (water pills).
    OR
  • ARBs (angiotensin-2 receptor blockers) AND diuretics (water pills).

Taking some medicines together can cause problems. This is called a medicine or drug interaction. A common interaction happens when you take anti-inflammatories while you take some blood pressure medicines. This can damage your kidneys. Read more about acute kidney injury.

What is the problem?

ACE inhibitors/ARBS and diuretics are often used to treat high blood pressure and heart failure. Taking these medicines together is safe, but it is not safe to take them with an anti-inflammatory as well.

Anti-inflammatory medicines are used for pain from headache, migraine, dental pain, back and muscle pain, arthritis, painful periods and pain following injury. They can help reduce fever, redness and swelling.

You can buy anti-inflammatories at your supermarket or pharmacy without a prescription, so you may take them without realising that this may cause harm to your kidneys. 

Anti-inflammatories 

Anti-inflammatory medicines are also called non-steroidal anti-inflammatories drugs (NSAIDs). They are used for pain from headache, migraine, dental pain, back and muscle pain, arthritis, painful periods and pain following injury. They can help reduce fever, redness and swelling. 

Read more about NSAIDs and risks of NSAIDs. 

Examples of NSAIDs

Medicine name Also called
Ibuprofen Brufen, Ibugesic, I-Profen, Nurofen, Advil, Medix
Combination medications  Nurofen Plus, Maxigesic, Nuromol, Brufen extra, Nurofen Cold and Flu, Ibucode Plus,Panfen Plus
Naproxen Noflam, Naprosyn SR
Diclofenac Voltaren, Diclofenac, Diclohexal, Apo-Diclo SR
Celecoxib Celebrex, Celostea

Blood pressure medicines

ACE inhibitors

Most ACE inhibitors have names that end in 'pril'. The following ACE inhibitors are available in New Zealand. Read more about ACE inhibitors.

ACE inhibitors available in New Zealand
  • captopril (Capoten)
  • cilazapril (Zapril, Apo-Cilazapri)
  • enalapril (Enalapril Ethics, Renitec M)

ACE inhibitors are sometimes combined with a diuretic (water tablet), eg:

  • cilazapril + hydrochlorothiazide
  • quinapril + hydrochlorothiazide (Accuretic®).

ARBs

Most ARBs have names that end in 'sartan'. The following ARBs are available in New Zealand:

  • candesartan
  • losartan
  • irbesartan.

ARBs are sometimes combined with a diuretic, eg, Karvezide, Arrow-Losartan & Hydrochlorothiazide, Entresto. Read more about ARBs. 

Water pills (diuretics)

Diuretics are medicines that help your body get rid of extra salt (sodium) and water. They work by increasing the amount of urine (pee) you make. Read more about diuretics. 

Medicine name Also called
Bendroflumethiazide (bendrofluazide)  Arrow-Bendrofluazide
 Chlortalidone  Hygroton, Igroton
 Indapamide  Dapa-Tabs
Metolazone Zaroxolyn, Metenix
Furosemide Lasix, Apo-Furosemide, Oedemid, Urex Forte, Furosemid Stada
Bumetanide Burinex
Amiloride Kaluril
Eplerenone Inspra, Eplerenone Te Arai
Spironolactone Spiractin, Spirotone
Combination medicines that include diuretics Frumil, Moduretic
Karvezide, Arrow-Losartan & Hydrochlorothiazide, Entresto

How can I prevent kidney damage?

  • If you take blood pressure medicines, you should avoid anti-inflammatories.
  • If you want to take anti-inflammatory medicines, check with your doctor or pharmacist first.
  • Only take one type of anti-inflammatory medicine at a time.
  • Take anti-inflammatories sparingly – take the smallest dose you need for the shortest possible time.
  • Do not exceed the recommended dose.

Read more about how to protect your kidneys.

Learn more

The Triple Whammy SafeRx, Waitematā DHB, NZ, 2013

Last reviewed: 21 Aug 2020