Moderate
Bisoprolol × Ibuprofen
Selective beta-adrenergic blockers×Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism
Similar to bisoprolol + ketorolac. Ibuprofen weakens the antihypertensive effect of the beta-blocker via renal prostaglandin blockade.
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.