Think before you prescribe

Combination of ACEI/ARBs + diuretic + NSAID may be nephrotoxic

Triple therapy with NSAIDs, diuretics and an ACEI/ARB is associated with increased risk of acute kidney injury.  In the retrospective cohort study of almost 500 000 patients published in BMJ. 2013 Jan 8;346:e8525, the overall risk increased by 31% with the simultaneous use of these three drugs. The use of a double therapy combination containing either a diuretic or ACEI or ARB with NSAIDs was not associated with an increased rate of acute kidney injury.

Since the observed risk was greatest at the start of treatment “first 30 days of use”, caution is warranted, especially during the initial few months of therapy. Monitor BP and serum creatinine when more than two anti-hypertensive drugs are used in combination with NSAIDs.

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