Drug Interactions Affecting Kidney Function: Beware of Health Threats from Triple Whammy

Tomasz Harężlak; Urszula Religioni; Filip M Szymański; Dagmara Hering; Agnieszka Barańska; Agnieszka Neumann-Podczaska; Matthew Allan; Piotr Merks

doi:10.1007/s12325-021-01939-9

Drug Interactions Affecting Kidney Function: Beware of Health Threats from Triple Whammy

Adv Ther. 2022 Jan;39(1):140-147. doi: 10.1007/s12325-021-01939-9. Epub 2021 Nov 29.

Authors

Tomasz Harężlak^{1

2}, Urszula Religioni³, Filip M Szymański⁴, Dagmara Hering⁵, Agnieszka Barańska⁶, Agnieszka Neumann-Podczaska⁷, Matthew Allan⁸, Piotr Merks⁹

Affiliations

¹ Collegium Medicum in Bydgoszcz, Nicolaus University, Torun, Poland.
² 10 Military Research Hospital in Bydgoszcz, Bydgoszcz, Poland.
³ Collegium of Business Administration, Warsaw School of Economics, Madalinskiego 6/8, 02-513, Warsaw, Poland. urszula.religioni@gmail.com.
⁴ Department of Civilization Diseases, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Kazimierza Woycickiego 1 Street, 01-938, Warsaw, Poland.
⁵ First Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland.
⁶ Department of Computer Science and Medical Statistics With the Studio of Remote Learning, Medical University of Lublin, 20-954, Lublin, Poland.
⁷ Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznan, Poland.
⁸ Ulladulla Medical Clinic, Philip Centre Shop 6/Princes Highway, Ulladulla, NSW, 2539, Australia.
⁹ Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, Kazimierza Woycickiego 1 Street, 01-938, Warsaw, Poland.

Abstract

Triple whammy (TW) is a potentially dangerous drug combination that can lead to acute kidney injury (AKI). This drug interaction (DI) occurs when angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are used together with diuretics and non-steroidal anti-inflammatory drugs (NSAIDs). One of the most serious consequences of TW DI is an increased risk of developing pre-renal acute kidney injury (pr-AKI). The term TW, in the context of a DI affecting kidney function, is not very widespread. The aim of this article was to gather information on this interaction. Previous knowledge on the mechanism of TW and how to increase patient awareness of this interaction is described. In addition, the specific nature of the acute kidney injury (AKI) caused by triple whammy (AKITW) is presented. On the basis of the current state of knowledge, recommendations on how to manage the TW DI are also demonstrated.

Keywords: ACEIs; Acute kidney injury; Drug interactions; NSAIDs; Triple whammy.

Publication types

Review

MeSH terms

Angiotensin Receptor Antagonists* / adverse effects
Angiotensin-Converting Enzyme Inhibitors* / adverse effects
Anti-Inflammatory Agents, Non-Steroidal / adverse effects
Diuretics / adverse effects
Drug Interactions
Humans
Kidney / drug effects*

Substances

Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Anti-Inflammatory Agents, Non-Steroidal
Diuretics