Lisinopril with ibuprofen
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Interaction Between Lisinopril and Ibuprofen: Clinical Implications
Introduction to Lisinopril and Ibuprofen Interaction
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is commonly prescribed for hypertension. Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), is frequently used for pain relief, including conditions like osteoarthritis. However, the concurrent use of these medications can lead to significant interactions, particularly affecting blood pressure control.
Impact of Ibuprofen on Blood Pressure in Hypertensive Patients
Several studies have demonstrated that ibuprofen can blunt the antihypertensive effects of lisinopril. In a controlled trial involving hypertensive patients, ibuprofen was shown to elevate systolic blood pressure by 7.7-9.9% in those taking a combination of lisinopril and hydrochlorothiazide. This interaction was not observed with acetaminophen, which had a negligible effect on blood pressure.
Mechanisms Behind the Interaction
The prohypertensive effects of NSAIDs like ibuprofen are primarily due to vasoconstriction. This mechanism was highlighted in a study where ibuprofen and piroxicam increased mean arterial pressure by 8.9-9.5% in patients on lisinopril/hydrochlorothiazide therapy. The study suggested that these effects are mainly due to vasoconstriction rather than volume expansion, as there were no significant changes in body weight, urinary output, or serum/urinary electrolyte profiles.
Clinical Case Study: Resistant Hypertension
A clinical case study of a 70-year-old woman with resistant hypertension further illustrates this interaction. Despite being on a regimen that included lisinopril and ibuprofen, her blood pressure remained elevated, ranging from 164 to 170 mm Hg systolic and 92 to 96 mm Hg diastolic. This case underscores the difficulty in managing hypertension when NSAIDs are part of the medication regimen.
Comparative Effects of Different NSAIDs
The interaction between antihypertensives and NSAIDs varies among different NSAIDs. In a study comparing ibuprofen, piroxicam, and acetaminophen, it was found that ibuprofen and piroxicam significantly impaired blood pressure control in patients on lisinopril/hydrochlorothiazide, while acetaminophen did not. This suggests that acetaminophen may be a safer alternative for pain management in hypertensive patients.
Conclusion
The concurrent use of lisinopril and ibuprofen can significantly impair blood pressure control due to the prohypertensive effects of ibuprofen. This interaction is primarily due to vasoconstriction rather than volume expansion. Clinicians should consider alternative pain management strategies, such as acetaminophen, for hypertensive patients to avoid compromising blood pressure control.
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