Diuretics, ACE inhibitors and NSAIDs — the triple whammy

  title={Diuretics, ACE inhibitors and NSAIDs — the triple whammy},
  author={M. Thomas},
  journal={Medical Journal of Australia},
  • M. Thomas
  • Published 2000
  • Medicine
  • Medical Journal of Australia
THE DELICATE BALANCE of modern polypharmacy is well illustrated by the common interaction of diure tics, angiotensin-converting enzyme (ACE) inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs) . Many patients, often elderly, with underlying vascular disease and poor perfusion, congestive heart failure or chronic renal failure, as well as arthritis, receive this combination therapy. However, it exposes them to significant risk: • NSAIDs and concurrent use of diuretics is associated… Expand
Nonsteroidal Anti-Inflammatory Drugs and the Kidney
This review summarizes the present knowledge how traditional NSAIDs and selective COX-2 inhibitors may affect the kidney under various experimental and clinical conditions, and how these drugs may influence renal inflammation, water transport, sodium and potassium balance and how renal dysfunction or hypertension may result. Expand
Drug combinations and impaired renal function -- the 'triple whammy'.
Taking two or more of the identified drugs was associated with significant renal impairment but did not correlate with heart failure or other diseases for which the drugs might have been prescribed. Expand
Combined use of nonsteroidal anti-inflammatory drugs with diuretics and/or renin-angiotensin system inhibitors in the community increases the risk of acute kidney injury.
The nephrotoxic potential of both dual and triple combinations of NSAIDs with renin-angiotensin system inhibitors and/or diuretics yields a higher incidence of AKI than previously thought. Expand
Non-steroidal anti-inflammatory drugs and atherothrombotic risk in older patients: where do we stand?
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The nephrotoxic “triple whammy” of combining diuretics, ACE inhibitors, and diuretics
Hapi and colleagues identified 2215 cases of acute kidney injury (AKI) during follow-up and identified an overall incidence of 7 in 10 000 (95% CI 7/10’�000 to 8/10″000) person years; a rapidly increasing incidence of serious AKI requiring dialysis. Expand
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
A triple therapy combination consisting of diuretics with angiotensin converting enzyme inhibitors or ang Elliotensin receptor blockers and NSAIDs was associated with an increased risk of acute kidney injury. Expand
Cyclo-Oxygenase-2 Inhibitors
Chronic pain in the elderly is frequently a result of arthritic disorders, particularly osteoarthritis. The cyclo-oxygenase (COX)-2 inhibitors are as effective as standard NSAIDs for the relief ofExpand
Non-Steroidal Anti-Inflammatory Drugs and Chronic Kidney Disease
CKD patients are at risk for adverse renal side-effects of NSAIDs, including acutely worsened renal function, hyperkalemia, hyponatremia, sodium retention, and exacerbation of hypertension, which are generally reversible upon discontinuation of the drugs. Expand
Effect of benazepril and robenacoxib and their combination on glomerular filtration rate in dogs
Benazepril and robenacoxib, administered alone or in combination, were tolerated well, did not decrease GFR with or without co-administration of furosemide and significantly reduced urinary aldosterone concentrations. Expand
Acute kidney injury secondary to a combination of renin-angiotensin system inhibitors, diuretics and NSAIDS: "The Triple Whammy".
Treatment with ACEI, ARB-II, diuretic and/or NSAIDs shows a high incidence of hospitalization episodes due to AKI; diuretics as monotherapy or dual and triple combination therapy cause the highest incidence. Expand


NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics.
Use of NSAIDs in elderly patients taking diuretics is associated with a 2-fold increased risk of hospitalization for CHF, especially in those with existing serious CHF. Expand
Counteraction of the vasodilator effects of enalapril by aspirin in severe heart failure.
In severe heart failure, the prostaglandin synthesis inhibition by aspirin counteracts the systemic arterial vasodilation of angiotensin-converting enzyme inhibition with enalapril and substantiates its dependence on the integrity of prostag landin metabolism. Expand
Analgesic and non-steroidal anti-inflammatory drug-associated acute renal failure: a prospective collaborative study.
Preventive measures should be especially directed to older patients receiving NSAID, by avoiding the combined use of drugs potentiating their action and by correcting any predisposing factor to ARF. Expand
Predic - tors of mortality and the provision of dialysis in patients with acute tubular necrosis
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