A cross-sectional exploratory survey on occurrence of triple-whammy prescription pattern in Japan

Abstract

A cross-sectional exploratory survey on occurrence of triple-whammy prescription pattern in Japan ABSTRACT Background: The concurrent use of nonsteroidal anti-inflammatory drugs, renin-angiotensin-aldosterone system blockers, and diuretics, known as a "triple-whammy," is related to the occurrence of acute kidney injury. However, there are few reports regarding the prescription pattern of the triple-whammy.Objective: To elucidate the patterns of the triple-whammy prescription in Japan. Methods:A cross-sectional study was performed using a health-insurance-claims database that included Japanese people under 75 years of age, and enrolled outpatients that were prescribed any nonsteroidal anti-inflammatory drugs, renin-angiotensin-aldosterone system blockers, and diuretics between April 2017 and June 2017. As an outcome, the proportion of triple-whammy prescriptions was evaluated.Among the patients who received triple-whammy prescriptions, we evaluated the prevalence of chronic kidney disease and the proportion of prescriptions provided for these three drugs from different clinical departments and institutions.Results: Overall, 730 of 246,721 (0.3%) patients received triple-whammy prescriptions. Among these patients, 13.3% had underlying chronic kidney disease. The proportions of any of the three drug types prescribed by different clinical departments and institutions was 48.2% and 61.8%, respectively. Conclusions:We examined the patterns of triple-whammy prescriptions and concluded that pharmacists need to pay attention to triple-whammy prescriptions if the prescriptions are provided by multiple clinical departments or institutions.

beware-of-triple-whammy

“…Fortunately, however, his serum creatinine readings recovered to his baseline serum creatinine after two days, coinciding with the withdrawal of celecoxib from the regime. Despite this, it cannot be doubted that the combination of "triple whammy" drugs presents an independent risk factor for AKI [2,3,5,10]. Therefore, in more unfortunate situations as far as the currently reported case is concerned, such as if a slight change in haemodynamic parameters were to occur (such as in hypoperfusion), a full-blown lethal complication could have ensued.…”

“…The prevalence of detected "triple whammy" occurrences in Malaysia is 0.5% [8], which is a figure that corresponds to findings from New Zealand (0.2%) [9]and Japan (0.3%) [10]. Despite the relatively low prevalence, "triple whammy" drugs (when used individually or in combination) are involved in over 50% of cases involving iatrogenic AKI reported to the ADRAC [6].…”

Counselling customers at risk of the triple whammy effect at community pharmacies – A feasibility study

“…It is well-documented that combining diuretics with angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin II receptor blockers (ARBs) and non-steroidal anti-inflammatory drugs (NSAID) involves a risk of acute renal failure. 1 , 2 This combination is known as triple whammy. The combination causes a 31% increased risk of acute renal failure, which increases within the first 30 days of treatment with NSAID.…”

“…Especially older people are at risk of drug-induced acute renal failure, as renal function decreases with age. 3 Some studies have investigated the prevalence of the combination of prescribed NSAID, ACE-i/ARBs and diuretics and found that 0.3% of patients ( N = 246,721, n = 730) 2 and 1.4% ( N = 2007, n = 28) 4 received prescriptions on medication combination increasing the risk of triple whammy effect (TWE).…”

A cross-sectional survey of hospitalization and blood tests implementation status in patients who received tolvaptan under 75 years of age using a Japanese claims database

“…However, the overall nationwide trends are unclear and should be evaluated for appropriate pharmacovigilance. Recently, several epidemiological surveys evaluating inappropriate drug use have been performed using medical big data sources, such as claims databases [14][15][16]. By employing medical big data, it may be possible to obtain generalized evidence.…”