Drug interactions
Enalapril-hydrochlorothiazide + Tolfenamic acid
Severity: Moderate
Enalapril-hydrochlorothiazide and Tolfenamic acid: 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 reduce the antihypertensive and diuretic effects of ACE inhibitors and thiazides. They also increase the risk of acute kidney injury, particularly in dehydrated or elderly patients, and may cause hyperkalemia.
What this interaction means in plain words
Enalapril-hydrochlorothiazide and Tolfenamic acid 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; Tolfenamic acid belongs to Musculoskeletal.
Why it happens
Inhibition of renal prostaglandin synthesis causes sodium retention and reduces renal perfusion, blunting antihypertensive effect and promoting kidney injury.
What to do
Avoid prolonged NSAID use where possible and ensure adequate hydration. Monitor blood pressure, 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 Tolfenamic acid
Frequently asked questions
Can I take Enalapril-hydrochlorothiazide with Tolfenamic acid?
MediHelp rates the interaction as moderate. Enalapril-hydrochlorothiazide and Tolfenamic acid 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 reduce the antihypertensive and diuretic effects of ACE inhibitors and thiazides. They also increase the risk of acute kidney injury, particularly in dehydrated or elderly patients, and may cause hyperkalemia.
How serious is the interaction between Enalapril-hydrochlorothiazide and Tolfenamic acid?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid prolonged NSAID use where possible and ensure adequate hydration. Monitor blood pressure, 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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