NSAIDs and blood pressure medicines

Also called the triple whammy

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

On this page, you can find the following information:


Why should some people avoid anti-inflammatories?

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 are taking some blood pressure medicines. ACE inhibitors/angiotensin receptor blockers (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. This can damage your kidneys. Read more about acute kidney injury. 

Although using NSAIDs with blood pressure medicines such as beta blockers and calcium channel blockers may be less harmful to your kidneys, NSAIDs must still be used very cautiously by people taking these medicines.

For more information, see NSAIDs learning activity. 

Studies have shown that all NSAIDs, except aspirin in low doses, can increase the chance of heart attack or stroke.

  • The risk may be greater if you have heart disease or risk factors for heart disease such as smoking, high blood pressure, high cholesterol or diabetes.
  • However, the risk of heart attack or stroke may also be increased in people who do not have heart disease or those risk factors.
  • Heart problems caused by NSAIDs can happen within the first weeks of use.
  • Heart problems may occur more often with higher doses or with long-term use.
  • NSAIDs should not be used right before or after heart bypass surgery.

Read more about the risks associated with taking NSAIDs.

Examples of anti-inflammatories 

Most people have no problem taking anti-inflammatories, but some people are seriously harmed by these medicines.  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 they may cause harm to your kidneys.

Read more about NSAIDs and risks 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

Examples of 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®).

Angiotensin receptor blockers (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

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 21 Aug 2020