Drug interaction affecting kidney function. Triple Whammy over 20 years
later
Abstract
Triple Whammy (TW) is a dangerous drug interaction (DI) that can occur
when combining angiotensin converting enzyme inhibitors (ACEIs) or
angiotensin II receptor blockers (ARBs), with diuretics and
non-steroidal anti-inflammatory drugs (NSAIDs). One of the most serious
consequences of TW is contributing to pre-renal acute kidney injury
(pr-AKI). Due to the fact that the term TW, in context of DI affecting
kidneys function is not very widespread, the aim of this article was to
gather information on this interaction. Previous knowledge on the
mechanism of TW and increasing patient awareness of this interaction is
described. In addition, the specific nature of the acute kidney injury
(AKI) caused by triple whammy (AKITW) is presented. On the basis of the
current state of knowledge, recommendations how to manage the TW DI are
also demonstrated.