Drug interactions
Indomethacin + Sacubitril-valsartan
Severity: Major
Indomethacin and Sacubitril-valsartan: major 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
Indomethacin reduces renal prostaglandin synthesis, which can impair kidney function in patients taking sacubitril-valsartan, especially if elderly or volume depleted. It may also blunt the antihypertensive and heart failure benefit and add to the risk of hyperkalemia and fluid retention.
What this interaction means in plain words
Indomethacin and Sacubitril-valsartan can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Indomethacin belongs to Musculoskeletal; Sacubitril-valsartan belongs to Cardiovascular.
Why it happens
NSAID inhibition of vasodilatory renal prostaglandins combined with angiotensin receptor blockade reduces glomerular filtration and potassium excretion.
What to do
Avoid combining where possible and use paracetamol or another alternative. If used, give the lowest dose for the shortest time and monitor creatinine, potassium and blood pressure.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Sacubitril-valsartan
- Aliskiren + Sacubitril-valsartan Contraindicated
- Benazepril + Sacubitril-valsartan Contraindicated
- Captopril + Sacubitril-valsartan Contraindicated
- Enalapril + Sacubitril-valsartan Contraindicated
- Fosinopril + Sacubitril-valsartan Contraindicated
- Lisinopril + Sacubitril-valsartan Contraindicated
Other interactions of Indomethacin
- Indomethacin + Ketorolac Contraindicated
- Indomethacin + Ketorolac intranasal Contraindicated
- Aceclofenac + Indomethacin Major
- Acemetacin + Indomethacin Major
- Acetylsalicylic acid + Indomethacin Major
- Alteplase + Indomethacin Major
Frequently asked questions
Can I take Indomethacin with Sacubitril-valsartan?
MediHelp rates the interaction as major. Indomethacin and Sacubitril-valsartan can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Indomethacin reduces renal prostaglandin synthesis, which can impair kidney function in patients taking sacubitril-valsartan, especially if elderly or volume depleted. It may also blunt the antihypertensive and heart failure benefit and add to the risk of hyperkalemia and fluid retention.
How serious is the interaction between Indomethacin and Sacubitril-valsartan?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid combining where possible and use paracetamol or another alternative. If used, give the lowest dose for the shortest time and monitor creatinine, potassium and blood pressure.
What other medicines interact with Sacubitril-valsartan?
MediHelp also lists interactions of Sacubitril-valsartan with, for example, Aliskiren, Benazepril, Captopril. The full list is on the Sacubitril-valsartan page.
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