The Impact of Concurrent Use of Diuretics, RAAS Inhibitors with Non-steroidal Anti-inflammatory Drugs “Triple Whammy” on Renal Function

Objective: This study aimed to evaluate the concomitant use of diuretics, angiotensin-converting-enzyme inhibitors/ angiotensin receptor blocker (ACEIs/ARBs) and non-steroidal anti-inflammatory drugs, frequently termed as “Triple Whammy,” prescribed among out-patients. It also aimed to determine the impact of this combination on patients’ renal function. Methodology: A retrospective and observational study was conducted in a hospital located in the state of Selangor, Malaysia. Patients who were receiving two or more of triple whammy agents were reviewed and analyzed. The associations between the prescriptions and patients’ demographics and comorbidities were tested using the Chi-square test. On the other hand, a paired sample t-test was used to determine the impact of prescriptions on renal function with a consideration of statistical significance when P < 0.05. Results: Out of 412 prescriptions (60.2% male) were included in this study, 407 prescriptions were containing two of the mentioned medication with only 5 prescriptions for triple whammy. The majority of prescriptions had (64.1%) ACEIs/ARBs and diuretics, and it was mainly prescribed to hypertensive patients (98.5%) aged less than 65 years old (38.3%). Furthermore, males were more likely to receive this combination of ACEIs/ARB and diuretics than females (P < 0.001) due to the fact that the male gender is considered as a risk factor for cardiovascular conditions that require ACEIs/ARBs + diuretics. In addition, there was a statistically significant decrease in CrCl after these risky combinations were initiated. Conclusion: The prescribing trend of triple whammy during the period of data collection was low compared to prescriptions of two risky combinations. This is indeed a good predictor of safe prescribing of drugs among physicians, as concomitant use of these three medications may impair renal functions.