Diuretics, ACE inhibitors and NSAIDs — the triple whammy

  title={Diuretics, ACE inhibitors and NSAIDs — the triple whammy},
  author={M. C. Thomas},
  journal={Medical Journal of Australia},
  • M. Thomas
  • Published 1 February 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… 
Nonsteroidal Anti-Inflammatory Drugs and the Kidney
  • W. Hörl
  • Medicine, Biology
  • 2010
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.
Determining Risk Factors for Triple Whammy Acute Kidney Injury
Computational models of long-term blood pressure regulation suggest that individual variations in water intake, the myogenic response, and drug sensitivity may predispose patients with hypertension to develop triple whammy-induced AKI.
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.
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.
Non-steroidal anti-inflammatory drugs and atherothrombotic risk in older patients: where do we stand?
Issues are discussed together with a proposed mechanism to explain the results of recent studies demonstrating a relatively low atherothrombotic risk associated with NSAIDs in older patients and Suggestions for future research directions are provided.
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.
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 of


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.
  • A. Portella
  • Medicine
    Rassegna internazionale di clinica e terapia
  • 1964
Predic - tors of mortality and the provision of dialysis in patients with acute tubular necrosis
  • J Am Soc Nephro /
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