MODERATE — Monitor Closely
FDA-documented interaction. Monitor blood pressure and renal function. Use acetaminophen instead when possible.
Evidence level: STRONG
Ibuprofen can make enalapril less effective for blood pressure and increase the strain on your kidneys. This is the same interaction seen with all ACE inhibitor and NSAID combinations.
Same ACE inhibitor + NSAID mechanism. NSAIDs reduce prostaglandin-dependent renal blood flow, decreasing ACE inhibitor efficacy and increasing nephrotoxicity. FDA labels warn.
Prefer acetaminophen for pain. If you use ibuprofen occasionally, it is unlikely to cause major problems, but regular use can undermine your blood pressure control.
Important: NSAIDs can reduce the blood pressure-lowering effect of ACE inhibitors and increase kidney damage risk (the "triple whammy" with diuretics). Use the lowest NSAID dose for the shortest time. Take Ibuprofen with food. Monitor blood pressure more frequently.
Higher risk for: those with renal impairment, hyperkalemia risk, concurrent potassium-sparing diuretics or potassium supplements, elderly, dehydrated patients, or those with bilateral renal artery stenosis.
Elevated blood pressure, decreased urination, ankle swelling
Use acetaminophen. If NSAID needed, shortest duration and lowest dose. Monitor renal function if chronic use.
ACE inhibitor interactions often involve potassium levels or blood pressure effects. Ask your doctor about ARBs as alternatives, or adjust the timing of the interacting substance. Monitor potassium levels and blood pressure regularly.
Ibuprofen can make enalapril less effective for blood pressure and increase the strain on your kidneys. This is the same interaction seen with all ACE inhibitor and NSAID combinations.
Important: NSAIDs can reduce the blood pressure-lowering effect of ACE inhibitors and increase kidney damage risk (the "triple whammy" with diuretics). Use the lowest NSAID dose for the shortest time. Take Ibuprofen with food. Monitor blood pressure more frequently.
Elevated blood pressure, decreased urination, ankle swelling
ACE inhibitor interactions often involve potassium levels or blood pressure effects. Ask your doctor about ARBs as alternatives, or adjust the timing of the interacting substance. Monitor potassium levels and blood pressure regularly.
Use acetaminophen. If NSAID needed, shortest duration and lowest dose. Monitor renal function if chronic use.
Or browse the full interaction database (121,000+ pairs).