I receive email Med Alerts as well as many print publications to keep up with the latest in medications, alternative treatments, adverse reactions and nutrient studies.
The April 2013 issue of Worst Pills, Best Pills published a Canadian study and a warning regarding the possibility of some antihypertensive drugs when taken with over-the-counter and prescription painkillers or non-steroidal anti-inflammatory drugs (NSAIDs). Some combinations may cause minor or even acute kidney injury (AKI). The publication indicated this was especially of concern among elderly patients with hypertension, diabetes, congestive heart failure or kidney disease.
As we age, our liver is not quite as capable of processing and detoxifying our bodies of certain foods and drugs. We slow down, and our organs do the same. For this reason it is often recommended that the elderly be prescribed lower dosages or less medications than younger patients.
The first warnings about the problems associated with mixing medications appeared in a British Medical Journal study in January. The study indicated that two antihypertensive drugs a diuretic plus either an angiotensin-converting enzyme (ACE) inhibitor (Altace, Lisinopril, Captopril, Capoten, Enalapril, Benzapril, Ramipril, etc.) or an angiotensin II receptor blocker (ARB), (Benicar, Atacand, Avapro, Cozaar, etc.) were the most problematic.
When AKI occurs, the kidneys’ filtering process is reduced. Additionally, the process by which the kidney controls fluids and electrolytes is disrupted. Patients with early AKI often have no symptoms, but as it becomes worse can cause a loss of appetite, nausea, vomiting, fatigue, weakness, edema, shortness of breath, and even higher blood pressure. NSAIDs are often used to control osteoarthritis and can adversely affect the kidneys by blocking the hormone-like substances known as prostaglandins. Prostaglandins control blood flow to the filters within the kidney.
At any rate, many patients use NSAIDs for inflammatory disorders or arthritis. Many of those same patients also use ACE inhibitors or ARBs to control blood pressure. What hasn’t been known until recently is that by taking NSAIDS while taking the above medications for blood pressure, both minor and major kidney disease may occur. NSAIDs include, but are not limited to, aspirin (Ecotrin, Anacin, Bayer), Trilisate, Dolobid, Celebrex, Cataflam, Pennsaid, Voltaren, Lodine, Motrin, Toradol, Indocin, Mobic, Naprosyn, Relafen, and ibuprofen.
It is now advised that if a patient is on any NSAID and the class of antihypertensive drugs known as ACE Inhibitors or ARBs, the NSAIDs may cause kidney damage. Because so many classes of drugs are involved and the list is longer than those I listed, it is best for patients to consult with their physicians to make certain they are not taking the combination.
Once again, it is more dangerous for those over 65 to be combining the two, according to the study. Check with your doctor or pharmacist to see if this combination may pose problems.
Dee Woods is available to give presentations about alternative health treatments and healthy living. She can be reached at