The short answer
- Occasional, short use (a day or two at normal doses, with food and fluids) is usually acceptable if your blood pressure is well controlled and your kidneys are healthy. Ask your pharmacist once.
- Avoid regular ibuprofen if you take an ACE inhibitor or ARB and a diuretic, have kidney disease or heart failure, or your blood pressure isn’t controlled.
- Safer options: paracetamol for most pain; an anti-inflammatory gel for joints and muscles.
What NSAIDs do to blood pressure and the kidneys
Prostaglandins help the kidneys widen their blood vessels, keep blood flowing and get rid of salt and water. Ibuprofen, naproxen, diclofenac, celecoxib and high-dose aspirin all reduce prostaglandins. The result is that the body holds on to more salt and water, blood pressure rises by a few mmHg on average (more in people who already have hypertension), and the kidneys become more dependent on other mechanisms to keep filtering.
Many blood pressure medicines rely on exactly those mechanisms. That is why NSAIDs blunt their effect and why, in some combinations, the kidneys can suddenly stop coping.
Which blood pressure medicines are affected?
| Blood pressure medicine |
Examples |
Effect of regular NSAIDs |
| ACE inhibitors |
Ramipril, perindopril (Coversyl), lisinopril, enalapril |
Less blood-pressure lowering; kidney injury risk; high potassium |
| ARBs (sartans) |
Candesartan (Atacand), irbesartan (Avapro), losartan, telmisartan |
As for ACE inhibitors |
| Diuretics |
Hydrochlorothiazide, indapamide, furosemide, spironolactone |
Less effective; kidney injury; high potassium with spironolactone |
| Beta blockers |
Metoprolol, atenolol, bisoprolol |
Less blood-pressure lowering |
| Calcium channel blockers |
Amlodipine, lercanidipine |
Least affected |
The “triple whammy”
An NSAID + an ACE inhibitor or ARB + a diuretic is the combination behind many medicine-related kidney injuries. Each one on its own reduces the kidney’s ability to protect its filtering pressure in a different way. Together, especially when you are dehydrated from heat, vomiting, diarrhoea or not drinking, kidney function can fall within days. Older people, and those with existing kidney disease, heart failure or diabetes, are most at risk. Many combination tablets hide two of the three in one pill: for example perindopril with indapamide, or irbesartan with hydrochlorothiazide.
Sick-day rule: if you take these medicines and become dehydrated (gastro, fever, heatwave), avoid NSAIDs completely and ask your doctor whether to pause the ACE inhibitor/ARB and diuretic until you are eating and drinking normally.
What to take for pain instead
| Option |
For people on blood pressure medicines |
| Paracetamol |
First choice for most pain. One trial (PATH-BP, 2022) found that taking the maximum dose of 4 g daily for two weeks raised systolic pressure by about 5 mmHg in people with hypertension, so use the lowest dose that works for long-term pain. |
| Ibuprofen or diclofenac gel |
Good for joint and muscle pain; much less absorbed |
| Ibuprofen tablets |
Short-term only, if your doctor agrees; avoid with the triple whammy |
| Low-dose aspirin (75–100 mg) |
Not a painkiller; doesn’t raise blood pressure |
| Heat, ice, physiotherapy |
Useful additions for back and joint pain |
The pros and cons of each painkiller are in the pain relief guide. Kidney and other interactions are summarised in our guide to combining medicines.
If you need an anti-inflammatory regularly
- Discuss it with your doctor rather than buying it over the counter.
- Expect a blood pressure check after a week or two, and a kidney function (creatinine) and potassium blood test.
- Use the lowest dose for the shortest time; drink enough fluids.
- Stop it and get advice if you notice ankle swelling, much less urine, breathlessness or rising home blood pressure readings.
Frequently asked questions
Can I take Nurofen with amlodipine?
Amlodipine is the blood pressure medicine least affected by NSAIDs. Occasional ibuprofen is usually fine, but if you also take an ACE inhibitor, ARB or diuretic, the cautions above apply.
Can I take Nurofen with ramipril or perindopril?
An occasional dose with food and fluids is usually acceptable for people with normal kidney function. Avoid regular use, and avoid it entirely if you also take a diuretic or are dehydrated.
Does Panadol raise blood pressure?
Occasional paracetamol doesn’t meaningfully affect blood pressure. Regular high doses (4 g a day) caused a small rise in one trial, so long-term use should be at the lowest effective dose and reviewed with your doctor.
Is Voltaren gel safe with blood pressure tablets?
Topical diclofenac produces much lower blood levels than tablets and is generally considered a safer option, though it is still worth telling your pharmacist about your blood pressure medicines.
Sources and further reading
CanforaMedicine Guide
