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All Journal Journal of Pharmacy and Clinical Practice Journal of Pharmacy and Clinical Practice
Suci Ahda Novitri
Program Studi Farmasi, Fakultas Ilmu Kesehatan, UIN Syarif Hidayatullah Jakarta, Banten 15412, Indonesia

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Tantangan Keamanan Terapi ACEi/ARB dan Diuretik dengan AINS: Tinjauan Nefrotoksisitas Triple Whammy, Faktor Risiko Populasi Rawat Jalan dan Manajemen Intervensi Farmasi Delila Eliza; Andi Utari Prasetya Nigrum; Suci Ahda Novitri; Adha Dastu Illahi; Mabrurotul Mustafidah
Journal of Pharmacy and Clinical Practice Vol. 1 No. 3 (2026): Journal of Pharmacy and Clinical Practice
Publisher : PT Bukuloka Literasi Bangsa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.65307/jpcp.v1i3.273

Abstract

The combination of Angiotensin-Converting Enzyme Inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB) and diuretics with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) can result in a drug interaction known as the "Triple Whammy". Concomitant use of these three drug classes is a leading cause of preventable iatrogenic Acute Kidney Injury (AKI) in outpatient populations. This narrative review aims to comprehensively outline the hemodynamic pathophysiology of "Triple Whammy" nephrotoxicity, analyze risk factors associated with AKI, and formulate pharmacist intervention management that applicable in primary healthcare settings. Literature review indicates that diuretics induce intravascular volume depletion, ACEi/ARBs abolish the compensatory vasoconstrictive response in efferent arterioles, and NSAIDs inhibit the synthesis of vasodilatory prostaglandins in afferent arterioles. This interaction leads to a failure of renal autoregulation and a drastic reduction in glomerular hydrostatic pressure. Drug combinations, duration of exposure, route of administration, cardiovascular comorbidities, and age are key risk factors for AKI. Preventing AKI requires pharmacist intervention through screening processes, the use of alternative medications, and reinforcement with Continuing Medical Education (CME)
Tantangan Keamanan Terapi ACEi/ARB dan Diuretik dengan AINS: Tinjauan Nefrotoksisitas Triple Whammy, Faktor Risiko Populasi Rawat Jalan dan Manajemen Intervensi Farmasi Delila Eliza; Andi Utari Prasetya Nigrum; Suci Ahda Novitri; Adha Dastu Illahi; Mabrurotul Mustafidah
Journal of Pharmacy and Clinical Practice Vol. 1 No. 3 (2026): Journal of Pharmacy and Clinical Practice
Publisher : PT Bukuloka Literasi Bangsa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.65307/jpcp.v1i3.273

Abstract

The combination of Angiotensin-Converting Enzyme Inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB) and diuretics with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) can result in a drug interaction known as the "Triple Whammy". Concomitant use of these three drug classes is a leading cause of preventable iatrogenic Acute Kidney Injury (AKI) in outpatient populations. This narrative review aims to comprehensively outline the hemodynamic pathophysiology of "Triple Whammy" nephrotoxicity, analyze risk factors associated with AKI, and formulate pharmacist intervention management that applicable in primary healthcare settings. Literature review indicates that diuretics induce intravascular volume depletion, ACEi/ARBs abolish the compensatory vasoconstrictive response in efferent arterioles, and NSAIDs inhibit the synthesis of vasodilatory prostaglandins in afferent arterioles. This interaction leads to a failure of renal autoregulation and a drastic reduction in glomerular hydrostatic pressure. Drug combinations, duration of exposure, route of administration, cardiovascular comorbidities, and age are key risk factors for AKI. Preventing AKI requires pharmacist intervention through screening processes, the use of alternative medications, and reinforcement with Continuing Medical Education (CME)
Co-Authors Adha Dastu Illahi Andi Utari Prasetya Nigrum Delila Eliza Mabrurotul Mustafidah