Drug interactions
Enalapril-hydrochlorothiazide + Piroxicam
Severity: Moderate
Enalapril-hydrochlorothiazide and Piroxicam: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
NSAIDs such as piroxicam can blunt the blood pressure lowering effect of enalapril and hydrochlorothiazide. In patients who are older, volume-depleted or have existing renal impairment, the combination can cause acute kidney injury, and the addition of a diuretic increases this risk.
What this interaction means in plain words
Enalapril-hydrochlorothiazide and Piroxicam can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Enalapril-hydrochlorothiazide belongs to Cardiovascular; Piroxicam belongs to Musculoskeletal.
Why it happens
NSAIDs inhibit synthesis of vasodilatory renal prostaglandins and cause sodium and water retention, opposing ACE inhibitor and diuretic effects and reducing glomerular perfusion.
What to do
Prefer a non-NSAID analgesic such as paracetamol where possible. If an NSAID is needed, use the lowest dose for the shortest time, ensure hydration, and monitor blood pressure, serum creatinine and potassium.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Enalapril-hydrochlorothiazide
- Aliskiren + Enalapril-hydrochlorothiazide Contraindicated
- Dofetilide + Enalapril-hydrochlorothiazide Contraindicated
- Enalapril-hydrochlorothiazide + Protein a column Contraindicated
- Enalapril-hydrochlorothiazide + Sacubitril / valsartan Contraindicated
- Amifostine + Enalapril-hydrochlorothiazide Major
- Amiloride + Enalapril-hydrochlorothiazide Major
Other interactions of Piroxicam
- Ketorolac intranasal + Piroxicam Contraindicated
- Ketorolac + Piroxicam Contraindicated
- Aceclofenac + Piroxicam Major
- Acemetacin + Piroxicam Major
- Acetylsalicylic acid + Piroxicam Major
- Alteplase + Piroxicam Major
Frequently asked questions
Can I take Enalapril-hydrochlorothiazide with Piroxicam?
MediHelp rates the interaction as moderate. Enalapril-hydrochlorothiazide and Piroxicam can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. NSAIDs such as piroxicam can blunt the blood pressure lowering effect of enalapril and hydrochlorothiazide. In patients who are older, volume-depleted or have existing renal impairment, the combination can cause acute kidney injury, and the addition of a diuretic increases this risk.
How serious is the interaction between Enalapril-hydrochlorothiazide and Piroxicam?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Prefer a non-NSAID analgesic such as paracetamol where possible. If an NSAID is needed, use the lowest dose for the shortest time, ensure hydration, and monitor blood pressure, serum creatinine and potassium.
What other medicines interact with Enalapril-hydrochlorothiazide?
MediHelp also lists interactions of Enalapril-hydrochlorothiazide with, for example, Aliskiren, Dofetilide, Protein a column. The full list is on the Enalapril-hydrochlorothiazide page.
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