Moderate
Amlodipine × Ibuprofen
Calcium channel blockers (dihydropyridines)×Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism
NSAIDs weaken amlodipine's antihypertensive effect via renal prostaglandin suppression. Additive acute kidney injury risk in dehydration.
Symptoms
Gradual blood pressure rise 1–2 weeks after starting the NSAID. In chronic kidney disease: risk of fluid retention and oedema.
Management
For short ibuprofen courses (5–7 days), monitor blood pressure. For chronic analgesia: switch to paracetamol, celecoxib (with PPI cover), or topical NSAIDs.