Dangerous combination of angiotensin converting enzyme inhibitors, diuretics, and nonsteroidal antiinflammatory drugs in clinical practice


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Abstract

The article presents a review of the scientific data on the issue of polypharmacy, particularly unfavorable combination of diuretics and blockers of the renin-angiotensin-aldosterone system (RAAS) with non-steroidal anti-inflammatory drugs (NSAIDs). Nephrotoxic side effects of NSAIDs (analgesic nephropathy) are well known. The use of NSAIDs significantly increases the risk of acute kidney damage in patients with cardiovascular disease who are taking diuretics and RAAS blockers. The combination of diuretics and NSAIDs may be accompanied by adverse renal impairment as a result of the interaction of the pharmacodynamic effects on renal hemodynamics, vascular tone and volaemia. Combination of NSAIDs with angiotensin converting enzyme inhibitors (ACE inhibitors), which have nephroprotective effect, leads to the counteraction of NSAIDs influence on the kidney. However, the triple combination of an ACE inhibitor+NSAIDs+ diuretics leads to acute renal dysfunction - iatrogenic kidney disease, which can be fatal. This combination is called «triple whammy», and recognized by the World Health Organization as an unfavorable combination, requiring special monitoring of renal function and the need to avoid the use in clinical practice.

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About the authors

M. V Leonova

FSBEI HE RNSMU n.a. N.I. Pirogov of RMH

Email: an-ti23@mail.ru
MD, Prof., Head of the Department of Clinical Pharma-cology of the Medical Faculty

E. E Alimova

FSBEI HE RNSMU n.a. N.I. Pirogov of RMH

Yu. N Eremina

FSBEI HE RNSMU n.a. N.I. Pirogov of RMH

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