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drug interaction(s) of NSAIDs, diuretics & ACE inhibitors

A triple whammy. Drug interactions: - combination of NSAID, diuretics, & ACE inhibitor or ARB increases risk of acute renal failure (31%) - an NSAID alone may increase systolic blood pressure - NSAIDs may precipitate decompensated acute heart failure in elderly taking ACE inhibitor or ARB & a diuretic [3] Mechanism of action: - diuretics can lead to hypovolemia - ACE inhibitors & ARBs cause a hemodynamic reduction in glomerular filtration rate due to efferent arteriolar vasodilation - NSAIDs cause inhibition of prostacyclin synthesis leading to renal afferent arteriolar vasoconstriction [2]

Properties

DRUGS: non-steroidal anti-inflammatory agent diuretic ACE inhibitor

References

  1. Prescriber's Letter 13(12): 2006 The Triple Whammy Detail-Document#: 221202 (subscription needed) http://www.prescribersletter.com
  2. Lapi F et al Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study. BMJ 2013;346:e8525 PMID: 23299844 http://www.bmj.com/content/346/bmj.e8525
  3. Sunaga T, Yokoyama A, Nakamura S et al. Association of potentially inappropriate medications with all-cause mortality in the elderly acute decompensated heart failure patients: importance of nonsteroidal anti-inflammatory drug prescription. Cardiol Res. 2020;11(4):239-246 PMID: 32595809 PMCID: PMC7295559 Free PMC article