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.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA
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