There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the FDA Drug Label
- 5 Non-Steroidal Anti-Inflammatory Agents including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors) In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including ramipril, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving ramipril and NSAID therapy. The antihypertensive effect of ACE inhibitors, including ramipril, may be attenuated by NSAIDs.
It is not entirely safe to take naproxen (a nonsteroidal anti-inflammatory drug (NSAID)) with ramipril (an angiotensin-converting enzyme (ACE) inhibitor), as it may result in deterioration of renal function, including possible acute renal failure, especially in patients who are elderly, volume-depleted, or with compromised renal function. Renal function should be monitored periodically in patients receiving ramipril and NSAID therapy 1.
From the Research
Interaction between Naproxen and Ramipril
- The use of naproxen with ramipril may increase blood pressure in hypertensive patients, as naproxen can blunt the effects of anti-hypertensive medications 2.
- A study found that naproxen significantly increased clinic and ambulatory systolic/diastolic blood pressure values in patients treated with ramipril 2.
- The combination of naproxen and ramipril may require careful evaluation and monitoring of patients, especially those with hypertension 2.
Cardiovascular Risk of Naproxen
- Naproxen is considered to be one of the safest non-steroidal anti-inflammatory drugs (NSAIDs) in terms of cardiovascular risk, especially when used at low doses 3, 4.
- A study found that naproxen users had the lowest adjusted rates of serious coronary heart disease and serious cardiovascular disease compared to other NSAIDs 4.
- However, the cardiovascular risk of naproxen may still be increased when used in combination with other medications, such as ramipril 2, 5.
Recommendations for Use
- International recommendations propose to avoid the use of NSAIDs, including naproxen, in patients at high cardiovascular risk 5.
- If the use of an NSAID is necessary, naproxen may be preferred due to its relatively safer cardiovascular profile, especially when co-administered with a proton pump inhibitor 5.
- Patients using naproxen with ramipril should be closely monitored for changes in blood pressure and renal function 2, 5.