Abstract
Drug–drug interaction between two drugs leads to a serious adverse drug reaction which is an adverse drug interaction. A 60-year-old female patient came with complaints of chest pain since 6 pm on the day of admission which is a burning type of pain and also a history of breathlessness. She was a known case of hypertension and diabetes mellitus since 5 years on medications, i.e. tablet atenolol-5 mg - 1-0-0, tablet amlodipine - 5 mg - 1-0-0, and tablet metformin - 500 mg - 1-0-1; the patient’s appetite was reduced and sleep was disturbed. On examination, blood pressure was 120/100 mmHg, pulse rate: 80 bpm, SpO2: 94% with room air, respiratory system: B/L coarse crept (+), and pallor (+) remaining systemic examination showing no any deformities. Laboratory reports show microcytic hypochromic with neutrophilia and thrombocytosis and ultrasonography (USG): B/L Grade I renal parenchymal disease. The patient ongoing treatment was tablet aspirin - 325 mg stat and 150 mg 0-1-0, tablet clopidogrel 300 mg stat and 75 mg 0-1-0, tablet atorvastatin 80 mg stat and 40 mg 0-0- 1, injection furosemide 40 mg IV 1-1-0, and injection nitroglycerin 2 amp in 1 pint NS at 12 drops/min and stopped on the 2nd day; injection pantoprazole 40 mg IV 1-0-1, injection heparin 5000 IU IV 1-1-1, and injection insulin R 8-8-6 S/C 1-0-1 started from the 2nd day; tablet enalapril 2.5 mg PO 1-0-1 given on the 2nd and 3rd days; tablet amlodipine 5 mg PO 1-0-1 given on the 2nd day and stopped; and injection insulin 1 pint in 25% dextrose, injection calcium gluconate, and nebulizer asthalin given only on the 3rd day. Here come 6 major interactions between amlodipine and clopidogrel, aspirin and furosemide (causes possible nephrotoxicity), clopidogrel with aspirin and heparin (increased risk of bleeding) and also heparin with nitroglycerin. The patient diagnosed as chronic kidney disease in the middle of the treatment which was adverse reaction interaction between aspirin and furosemide.
Highlights
Aspirin may reduce the diuretic effect of bumetanide, furosemide, or piretanide and reduce the venodilation produced by furosemide
Major interactions a) Amlodipine ⬄ Clopidogrel: Concurrent use of amlodipine and clopidogrel may result in decreased antiplatelet effect and increased risk of thrombotic events. b) Aspirin⬄ Furosemide: Concurrent use of loop diuretics and NSAIDs may result in reduced diuretic effectiveness and possible nephrotoxicity. c) Clopidogrel ⬄ Aspirin: Concurrent use of aspirin and clopidogrel may result in an increased risk of bleeding. d) Clopidogrel ⬄ Heparin: Concurrent use of anticoagulants and antiplatelet agents may result in increased risk of bleeding. e) Heparin ⬄ Aspirin: Concurrent use of anticoagulants and antiplatelet agents may result in increased risk of bleeding. f) Nitroglycerin ⬄ Heparin: Concurrent use of heparin and nitroglycerin may result in a decreased partial thromboplastin time
Aspirin may inhibit renal prostaglandins which appear to mediate the increased renal blood flow induced by loop diuretics in cirrhotic with ascites
Summary
Aspirin may reduce the diuretic effect of bumetanide, furosemide, or piretanide and reduce the venodilation produced by furosemide. The combination of aspirin and furosemide may increase the risk of acute renal failure and salicylate toxicity. Intravenous furosemide causes a prompt increase in systemic venous capacitance and decreases left ventricular (LV) filling pressure, even before the saluretic response is apparent. This action appears to be PG mediated and is responsible for the quick relief it affords in LV failure and pulmonary edema. Aspirin is a weaker analgesic (had lower maximal efficacy) than morphine type drugs: aspirin 600 mg~codeine 60 mg It effectively relieves inflammatory, tissue injury-related, connective tissue, and integumental pain but is relatively ineffective in severe visceral and ischemic pain. WBC: White blood cell, MCH: Mean corpuscular hemoglobin, MCV: Mean corpuscular volume, MCHC: Mean corpuscular hemoglobin concentration
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