drug interaction(s) of NSAIDs, diuretics & angiotensin II receptor antagonists
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Introduction
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]
More general terms
References
- ↑ Prescriber's Letter 13(12): 2006 The Triple Whammy Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=221202&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 2.0 2.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23299844 <Internet> http://www.bmj.com/content/346/bmj.e8525
- ↑ 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/32595809 PMCID: PMC7295559 Free PMC article