what is the possible effect for giving an ACE +NSID+diuretics in elderly patients?
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Thanks for your question,
- Answered 4 Sep 2019 Conflict of interest declaration: None There are papers, such as “Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study” , this concludes: “A triple therapy combination consisting of diuretics with angiotensin converting enzyme inhibitors or angiotensin receptor blockers and NSAIDs was associated with an increased risk of acute kidney injury. The risk was greatest at the start of treatment. Although antihypertensive drugs have cardiovascular benefits, vigilance may be warranted when they are used concurrently with NSAIDs.” Other papers report similar findings, for instance  reports: “Thus, the nephrotoxic potential of both dual and triple combinations of NSAIDs with renin–angiotensin system inhibitors and/or diuretics yields a higher incidence of AKI than previously thought.” You may also be interested in these two general reviews of the topic: “Avoiding the triple whammy in primary care: ACE inhibitor/ARB + diuretic + NSAID”  and “Diuretics, ACEIs, ARBs, and NSAIDs: A Nephrotoxic Combination”  Finally, you should explore drug interaction sites such as https://www.webmd.com/interaction-checker/default.htm and https://www.drugs.com/drug_interactions.html, these both highlight different problems depending on the exact combination of drugs. References 1) https://www.bmj.com/content/346/bmj.e8525 2) https://www.sciencedirect.com/science/article/pii/S2157171615321638 3) https://bpac.org.nz/2018/docs/triple-whammy.pdf 4) https://www.pharmacytimes.com/publications/issue/2013/april2013/diuretics-aceis-arbs-and-nsaids-a-nephrotoxic-combination