Advil With Lisinopril And Hydrochlorothiazide

There is a potential interaction between all three drugs: Advil, lisinopril and hydrochlorothiazide.

Question

I take 40mg of lisinopril 25 mg of atenol and hydrochlorothiazide 12.5 mg. Is it safe to take Advil for pain?

Asked by deerhunter On Nov 17, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Nov 18, 2018
Three Pill Bottles Spilling

Overview

There are a number of potential interactions between the medications you listed in your question, which are discussed below.

All the potential interaction involve adverse effects on kidney function and increases in blood pressure.

You can use our 'Drug Interaction Checker' to view these interactions as well.


Advil With Blood Pressure Meds

There is essentially a blanket warning when combining any blood pressure medication (e.g. atenolol, hydrochlorothiazide) and a NSAID (non-steroidal anti-inflammatory drug), like Advil.

From our Interaction Checker:

"Non-steroidal anti-inflammatory drugs (NSAIDs) can produce vasoconstriction leading to an increase in blood pressure. This can increase the risk of hypertension in those being treated with beta-blocker anti-hypertensives."

Essentially, all NSAIDs have been associated with increases in blood pressure as they reduce the formation of prostaglandins.

This can not only reduce kidney function but also cause:

  • Increases in blood pressure
  • Edema and weight gain

The elderly and individuals with impaired kidney function are more at risk for this interaction.

This interaction also applies to Advil with hydrochlorothiazide (in regard to a possible decrease in kidney function).

Generally, short term use of NSAIDs are perfectly fine for most individuals, but it is important to check with your doctor first.

Section Summary
Short term use of Advil and blood pressure medication is generally okay, but watch for spikes in blood pressure. Individuals with kidney impairment should speak with their doctor first.

Advil With Lisinopril

The interaction between Advil and lisinopril is similar to the general NSAID warning with blood pressure medication.

However, there is an addition concern with this combination since both can increase potassium levels kidney impairment.

From our Interaction Checker:

"As NSAIDs may cause an increase in blood pressure, concomitant use of NSAIDs may reduce the hemodynamic effects of ACE inhibitors. NSAIDs may also reduce the renal excretion of ACE inhibitors, leading to increased plasma concentrations of ACE inhibitors and increased risk for drug-related adverse reactions. Both ACE inhibitors and NSAIDs have potassium-elevating properties which can lead to hyperkalemia. The use of both agents is also associated with an increased risk of renal impairment."

Numerous studies have explored the potential effects of NSAIDs and ACE-Inhibitors. In most individuals, the combination is okay, but, for some, it can be dangerous, especially if you are on additional medications that can affect renal function.

Section Summary
The combination of NSAIDs, like Advil, and ACE-Inhibitors can alter kidney function and increase blood pressure.

Additional Thoughts

As your drug interaction query involves multiple potential issues, all revolving around kidney function and increases in the blood pressure, it is important you speak with your doctor prior to using Advil.

The combination you describe (ACE-Inhibitor, diuretic such as hydrochlorothiazide and NSAID) has been labeled as the 'Triple Whammy' by some sources, and there is certainly a risk of kidney problems if they are all used together.


References
  1. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. PubMed
  2. PharmacistAsnwers Interaction Checker (DrugBank). PharmacistAnswers
  3. Non-steroidal anti-inflammatory drugs: how do they work? PubMed
  4. Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: a population-based cohort study. PubMed
  5. Diuretics, ACEIs, ARBs, and NSAIDs: A Nephrotoxic Combination. Pharmacy Times
  6. Pharmacokinetic drug interactions with ACE inhibitors. PubMed

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Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

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