ACEIS, DUIRETICS AND NSAIDS :
This triple therapy can increase the risk of acute renal failure.
Diuretics, angiotensin-converting enzyme inhibitors (ACEIs), and
angiotensin receptor blockers (ARBs) represent 3 classes of drugs widely
used in the treatment of hypertension and heart failure, often in
combination. In addition to blunting the hypotensive effects of
diuretics, ACEIs, and ARBs, there is an increased risk of patients
developing acute renal failure when an NSAID is co-administered.
Mechanism of the Interaction
Diuretics can reduce plasma volume leading to reduced renal blood flow.
This may lead to increased serum creatinine concentrations. The kidney
can compensate via the renin-angiotensin system by constricting the
efferent renal arteriole to increase glomerular filtration pressure and
favor water and sodium retention. ACEIs and ARBs inhibit efferent renal
arteriolar vasoconstriction that lowers glomerular filtration pressure.
NSAIDs, by inhibition of prostaglandins and bradykinin, produce
vasoconstriction of the afferent renal arteriole and reduce the ability
of the kidney to regulate (increase) glomerular blood flow. When triple
therapy with an NSAID plus diuretic and an ACEI or ARB is administered,
the kidney is unable to use its normal compensatory mechanisms and may
suffer an acute reduction in glomerular filtration that is marked by a
rising serum creatinine.
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