MajorAngiotensin-converting enzyme inhibitors (ACEi)×Non-steroidal anti-inflammatory drugs (NSAIDs)
Updated · Methodology
Mechanism
Ibuprofen (NSAID) suppresses prostaglandin synthesis maintaining glomerular perfusion at lower blood pressure. On enalapril, which dilates efferent arterioles, the combination raises acute kidney injury risk (the 'triple whammy' with a diuretic is more dangerous still).
Symptoms
Reduced urine output, rising creatinine and potassium. Blood pressure rise and oedema. Symptoms appear earlier in older patients and chronic kidney disease.
Management
Avoid chronic ibuprofen on enalapril. If a short course is needed, use the minimum effective dose for 5–7 days with pantoprazole cover. For chronic analgesia: paracetamol, celecoxib, or topical NSAIDs.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- KDIGO: KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD (2024)– Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024;105(4S):S117-S314.
- AEMPS: Ficha técnica: Ibuprofeno (nº registro 63597), sección 4.5 (2025)– AEMPS, CIMA, nº registro 63597, revisión 04/2025, sección 4.5
- AEMPS: Ficha técnica: Enalapril (nº registro 63355), sección 4.5 (2025)– AEMPS, CIMA, nº registro 63355, revisión 08/2025, sección 4.5