Laboratory Monitoring of Patients Treated with Antihypertensive Drugs and Newly Exposed to Non Steroidal Anti-Inflammatory Drugs: A Cohort Study

Abstract

Background Drug-Drug Interactions between Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and Angiotensin Converting Enzyme Inhibitors (ACEIs), Angiotensin Receptor Blocker (ARBs) or diuretics can lead to renal failure and hyperkalemia. Thus, monitoring of serum creatinine and potassium is recommended when a first dispensing of NSAID occur in patients treated with these drugs. Methods We conducted a pharmacoepidemiological retrospective cohort study using data from the French Health Insurance Reimbursement Database to evaluate the proportion of serum creatinine and potassium laboratory monitoring in patients treated with ACEI, ARB or diuretic and receiving a first dispensing of NSAID. We described the first dispensing of NSAID among 3,500 patients of a 4-year cohort (6,633 patients treated with antihypertensive drugs) and analyzed serum creatinine and potassium laboratory monitoring within the 3 weeks after the first NSAID dispensing. Results General Practitioners were the most frequent prescribers of NSAIDs (85.5%, 95% CI: 84.3–86.6). The more commonly prescribed NSAIDs were ibuprofen (20%), ketoprofen (15%), diclofenac (15%) and piroxicam (12%). Serum creatinine and potassium monitoring was 10.7% (95% CI: 9.5–11.8) in patients treated by ACEIs, ARBs or diuretics. Overall, monitoring was more frequently performed to women aged over 60, treated with digoxin or glucose lowering drugs, but not to patients treated with ACEIs, ARBs or diuretics. Monitoring was more frequent when NSAIDs' prescribers were cardiologists or anesthesiologists. Conclusion Monitoring of serum creatinine and potassium of patients treated with ACEIs, ARBs or diuretics and receiving a first NSAID dispensing is insufficiently performed and needs to be reinforced through specific interventions.

Drug interactions between antihypertensive drugs and non‐steroidal anti‐inflammatory agents: a descriptive study using the French Pharmacovigilance database

“…Moreover, we demonstrated that NSAIDs were less frequently found in older patients exposed to antiplatelet drugs. We found similar results in the cohort of hypertensive patients , suggesting that age and level of cardiovascular risk could be factors leading to less NSAID's prescriptions.…”

“…We showed that exposure to NSAIDs was no more than 4.5% in patients treated with antihypertensive drugs. This low prevalence could be reassuring, but should be interpreted with caution: We recently demonstrated that in a cohort of patients treated with antihypertensive dugs, the incidence of NSAID's exposure was 25.1/100 person-years [9]. Ketoprofen, diclofenac, ibuprofen, nimesulide, and naproxen were the most commonly prescribed NSAIDs in the population of patients treated with antihypertensive drugs in the present study.…”

Rationale and Design of a Randomized Placebo-Controlled Clinical Trial Assessing the Renoprotective Effects of Potassium Supplementation in Chronic Kidney Disease

“…The first situation is when they start any novel drug (prescription or over-the-counter) or find a need to use non-steroidal anti-inflammatory drugs. The reason to do so is that several commonly used drugs (e.g., cotrimoxazole, non-steroidal anti-inflammatory drugs) predispose to hyperkalemia, especially in patients using RAAS-blockers [37,38]. The second situation is in the case of dose adjustments of prescribed drugs (e.g., RAAS-blockers), when the research team will decide whether this justifies earlier monitoring of serum K + through an additional study visit.…”

Fracaso renal agudo secundario a combinación de inhibidores del sistema renina-angiotensina, diuréticos y AINES. “La Triple Whammy”1

“…Como limitaciones tenemos el reducido número de casos y no haber incluido el tratamiento con AAS a pequeñas dosis (100 y 300 mg) como efecto AINE sino como antiagregante, como así consta en la codificación farmacéutica, ya que gran parte de los pacientes ingresados (19), se encontraban en tratamiento profiláctico con estas dosis. Paracetamol a dosis mayor de 4 g/d, podría también tener un efecto AINE.…”