Drug interactions
Hydrochlorothiazide-irbesartan + Tolmetin
Severity: Moderate
Hydrochlorothiazide-irbesartan and Tolmetin: 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 tolmetin can blunt the blood pressure lowering effect of irbesartan and hydrochlorothiazide. In patients who are elderly, volume depleted or have reduced kidney function, the combination can cause acute kidney injury and hyperkalemia.
What this interaction means in plain words
Hydrochlorothiazide-irbesartan and Tolmetin 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.
Hydrochlorothiazide-irbesartan belongs to Cardiovascular; Tolmetin belongs to Musculoskeletal.
Why it happens
NSAIDs inhibit vasodilatory renal prostaglandins, causing sodium and water retention and reduced glomerular perfusion, which opposes antihypertensive action and adds to renal hemodynamic stress with ARBs and diuretics.
What to do
Monitor blood pressure, serum creatinine and potassium after starting or changing the NSAID, and keep patients well hydrated. Use the lowest effective NSAID dose for the shortest time or choose an alternative analgesic.
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 Hydrochlorothiazide-irbesartan
- Aliskiren + Hydrochlorothiazide-irbesartan Contraindicated
- Dofetilide + Hydrochlorothiazide-irbesartan Contraindicated
- Hydrochlorothiazide-irbesartan + Sparsentan Contraindicated
- Aldesleukin + Hydrochlorothiazide-irbesartan Major
- Amifostine + Hydrochlorothiazide-irbesartan Major
- Amiloride + Hydrochlorothiazide-irbesartan Major
Other interactions of Tolmetin
- Ketorolac intranasal + Tolmetin Contraindicated
- Ketorolac + Tolmetin Contraindicated
- Aceclofenac + Tolmetin Major
- Acemetacin + Tolmetin Major
- Alteplase + Tolmetin Major
- Amlodipine-hydrochlorothiazide-valsartan + Tolmetin Major
Frequently asked questions
Can I take Hydrochlorothiazide-irbesartan with Tolmetin?
MediHelp rates the interaction as moderate. Hydrochlorothiazide-irbesartan and Tolmetin 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 tolmetin can blunt the blood pressure lowering effect of irbesartan and hydrochlorothiazide. In patients who are elderly, volume depleted or have reduced kidney function, the combination can cause acute kidney injury and hyperkalemia.
How serious is the interaction between Hydrochlorothiazide-irbesartan and Tolmetin?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood pressure, serum creatinine and potassium after starting or changing the NSAID, and keep patients well hydrated. Use the lowest effective NSAID dose for the shortest time or choose an alternative analgesic.
What other medicines interact with Hydrochlorothiazide-irbesartan?
MediHelp also lists interactions of Hydrochlorothiazide-irbesartan with, for example, Aliskiren, Dofetilide, Sparsentan. The full list is on the Hydrochlorothiazide-irbesartan page.
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