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 can reduce the antihypertensive effect of sacubitril/valsartan and increase the risk of acute kidney injury, especially in older, volume-depleted or renally impaired patients. Hyperkalemia may also be worsened.
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.
Why it happens
NSAID inhibition of vasodilatory renal prostaglandins constricts the afferent arteriole while valsartan dilates the efferent arteriole, reducing glomerular filtration, with added sodium retention and reduced potassium excretion.
What to do
Avoid the combination where possible; if used, monitor renal function, serum potassium and blood pressure closely, and ensure adequate hydration.
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 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 can reduce the antihypertensive effect of sacubitril/valsartan and increase the risk of acute kidney injury, especially in older, volume-depleted or renally impaired patients. Hyperkalemia may also be worsened.
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 the combination where possible; if used, monitor renal function, serum potassium and blood pressure closely, and ensure adequate hydration.
What other medicines interact with Indomethacin?
MediHelp also lists interactions of Indomethacin with, for example, Ketorolac, Ketorolac intranasal, Aceclofenac. The full list is on the Indomethacin page.
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