The Pharmaceutical Journal
Vol 268 No 7198 p694-696
18 May 2002

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European Society of Clinical Pharmacy summary

Interaction warning for NSAIDs

Patients on angiotensin-converting enzyme (ACE) inhibitors are at increased risk of renal dysfunction when they start using non-steroidal anti-inflammatory drugs (NSAIDs), said Dr MARCEL BOUVY, SIR Institute for Pharmacy Practice Research, Leiden, Netherlands.

It is known that both drugs can cause renal insufficiency but this study examined the risk of giving NSAIDs to patients already taking ACE inhibitors. A database was searched for patients admitted to hospital with renal insufficiency during use of ACE inhibitors; 144 patients were identified and compared with a control group of 1,189 patients.

Patients who started NSAIDs during the three months before hospital admission were found to be at increased risk of renal dysfunction (odds ratio, 2.2, 95 per cent confidence interval 1.1–4.5). A greater risk was found for patients who had both started NSAIDs during the three months before admission and had been given more than three prescriptions for NSAIDs (odds ratio, 7.1, CI 1.8–28.7). No increased risk was found for chronic users of NSAIDs, indicating that the problems occurred at the start of use.

"The study indicates that there is an increased risk of hospitalisation for renal dysfunction at the start of NSAID therapy in users of ACE inhibitors," said Dr Bouvy. He recommended that NSAIDs should be avoided in people who use ACE inhibitors. This included cyclo-oxygenase-2 selective inhibitors because these drugs had the same effect on the kidney as other NSAIDS, he added.