Indometacin may attenuate the antihypertensive effect of losartan, valsartan, or other angiotensin II receptor antagonists. No clinically relevant pharmacokinetic inter- actions occur between telmisartan and ibuprofen or between valsartan and indometacin. The combination of an NSAID and angiotensin II receptor antagonist can increase the risk of renal impairment and hyperkalaemia.
Several manufacturers of angiotensin II receptor antagonists caution that, as with other antihypertensives, the effects on blood pressure may be attenuated by NSAIDs such as indometacin. Patients taking losartan, valsartan or other angiotensin II receptor antagonists, who require indometacin, should be moni- tored for alterations in blood pressure control. Other NSAIDs seem likely to interact similarly. Poor renal perfusion may increase the risk of renal failure if angiotensin II receptor antagonists are given with NSAIDs and so regular hydration of the patient and monitoring of renal function is recommended.
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