JRSM > Volume 94, Number 12 > Pp. 657-658

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Nephrotoxicity in the elderly due to co-prescription of ACE inhibitors and NSAIDs

O M P Jolobe

Department of Adult Medicine, Tameside General Hospital, Ashton-under-Lyne OL6 9RW, UK

The report by Dr Adhiyaman and others (October 2001 JRSM, pp. 512-514) of renal failure after co-prescription of angiotensin converting enzyme (ACE) inhibitors and nonsteroidal anti-inflammatory drugs (NSAIDs), together with findings on renal function in elderly heart failure patients¹, should invoke even greater vigilance in the era following the RALES study (which reported survival benefit from co-prescription of spironolactone and ACE inhibitors in heart failure). Already there are reports not only of deterioration in renal function but also of hyperkalaemia complicating co-prescription of ACE inhibitors, spironolactone, and NSAIDs^3,4. Spironolactone aggravates the impairment of potassium excretion in renal failure. NSAIDs are liable to impair potassium excretion in their own right, because they can induce hyporeninaemic hypoaldosteronism, which, in turn, impairs renal potassium excretion⁵. Selective cyclo-oxygenase-2 (COX-2) inhibitors also seem to carry some risk of nephrotoxicity, as judged by anecdotal reports of acute renal failure associated with rofecoxib⁶ and celecoxib⁷, so these drugs may differ little in this respect from conventional NSAIDs. Perhaps the time has come for indiscriminate prescription of NSAIDs to be used as an indicator of clinical underperformance.

REFERENCES

1. Jolobe OMP. Evaluation of renal function in elderly heart failure patients on ACE inhibitors. Postgrad Med J1998; 75:275 -7[Abstract/Free Full Text]

2. Pitt B, Zannad F, Remme W, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med1999; 341:709 -17[Abstract/Free Full Text]

3. Berry C, McMurray JJV. Serious adverse events experienced by patients with chronic heart failure taking spironolactone. Heart2001; 85:e8[Abstract/Free Full Text]

4. Schepkens H, Vanholder R, Billiouw J-M, Lamiere N. Life-threatening hyperkalemia during combined therapy with angiotensin-converting enzyme inhibitors and spironolactone: an analysis of 25 cases. Am J Med 2001;110:438 -41[Medline]

5. Tan SY, Shapiro R, Franco R, et al. Indomethacin-induced prostaglandin inhibition with hyperkalemia: a reversible cause of hyporeninemic hypoaldosteronism. Ann Intern Med1979; 90:783 -5

6. Wolf G, Porth J, Stahl RAK. Acute renal failure with rofecoxib. Ann Intern Med2000; 133:394[Free Full Text]

7. Parazella MA, Tray K. Selective cyclooxygenase-2 inhibitors: a pattern of nephrotoxicity similar to traditional nonsteroidal anti-inflammatory drugs. Am J Med2001; 111:64 -6[Medline]

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jolobe, O M P Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?