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Nonsteroidal anti-inflammatory drugs (standard or coxibs) - prescribing issues - Management
What should I do for a person who requires a diuretic and an NSAID?

  • Thiazide-type diuretics:
    • Indometacin may reduce the antihypertensive effect of thiazides. With concurrent use of a thiazide-type diuretic and indometacin, blood pressure should be regularly monitored and the thiazide dosage increased as necessary.
      • This interaction is less likely with other nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Loop diuretics:
    • There is generally no need to avoid the concomitant use of a loop diuretic and an NSAID, but monitoring is necessary, because:
      • The antihypertensive effect may be reduced.
      • The diuretic effects may be reduced.
      • Diuretics increase the risk of NSAID-induced renal impairment and failure.
    • If a reduced antihypertensive or diuretic effect occurs, the dose of the loop diuretic can be increased:
      • If increasing the diuretic dose is ineffective, switch to an NSAID which is considered to interact less significantly (e.g. ibuprofen).
    • If NSAID-induced renal impairment occurs, either switch the NSAID to a non-NSAID analgesic or switch the diuretic.
  • Potassium-sparing diuretics:
    • Avoid concomitant use of triamterene and indometacin because risks of reduced renal function and rapid development of acute renal failure are increased.
    • It is good practice to use caution when any NSAID is used with triamterene.
    • Use of a potassium-sparing diuretic with an NSAID may increase the risk of hyperkalaemia; therefore, serum potassium levels need to be monitored.
Basis for recommendation
  • These recommendations are based on information in an authoritative reference manual on drug interactions and in the British National Formulary [Baxter, 2006; BNF 55, 2008].
    • The interaction between thiazide-type diuretics and indometacin is well established, but other NSAIDs appear to interact to a lesser extent or not at all [Baxter, 2006].

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