Abstract
BackgroundDrug-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.MethodsWe 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.ResultsGeneral 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.ConclusionMonitoring 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.
Highlights
Because Non Steroidal Anti-Inflammatory Drugs (NSAIDs) inhibit cyclooxigenase enzymes (COX) and prevent prostaglandin synthesis, their drug-drug interactions (DDIs) with antihypertensive drugs can lead to adverse drug reactions [1]
Recommendations are to monitor serum creatinine alone [4], and even serum creatinine and potassium [5] whenever NSAIDs are first prescribed with Angiotensin Converting Enzyme Inhibitors (ACEIs), Angiotensin Receptors Blockers (ARBs) or diuretics (Table S1)
General Practitioners (GPs) prescribed the majority of NSAIDs (85.5%, 95% CI: 84.3–86.6), and mainly ibuprofen (18.6%), diclofenac (16.3%), ketoprofen (15.4%) or piroxicam (13.4%)
Summary
Because Non Steroidal Anti-Inflammatory Drugs (NSAIDs) inhibit cyclooxigenase enzymes (COX) and prevent prostaglandin synthesis, their drug-drug interactions (DDIs) with antihypertensive drugs can lead to adverse drug reactions [1]. Concomitant use of NSAIDs with Angiotensin Conversion Enzyme inhibitors (ACEIs), Angiotensin Receptors Blockers (ARBs) or diuretics can precipitate acute renal failure, hyponatremia or hyperkalemia, especially when used on elderly or dehydrated individuals. The concise information provided in this guideline is used by the main drug databases (especially the French National Formulary: VidalH [4]). Recommendations are to monitor serum creatinine alone [4], and even serum creatinine and potassium [5] whenever NSAIDs are first prescribed with ACEIs, ARBs or diuretics (Table S1). 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. Monitoring of serum creatinine and potassium is recommended when a first dispensing of NSAID occur in patients treated with these drugs
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