Exposure of the elderly to potential nephrotoxic drug combinations in Belgium

Authors

  • Hilde LE Smets MD,

    1. Department of Nephrology-Hypertension, Antwerp University Hospital, Belgium
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  • Johan FF De Haes MPharm,

    1. National Institute for Health and Disability Insurance (RIZIV-INAMI), Brussels, Belgium
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  • André De Swaef MPharm,

    1. National Institute for Health and Disability Insurance (RIZIV-INAMI), Brussels, Belgium
    2. Faculty of Medicine and Pharmacy, Free University of Brussels (VUB), Brussels, Belgium
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  • Philippe G Jorens MD, PhD,

    1. Department of Pharmacotherapy, University of Antwerp/Antwerp University Hospital, Belgium
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  • Gert A Verpooten MD, PhD

    Corresponding author
    1. Department of Nephrology-Hypertension, Antwerp University Hospital, Belgium
    2. Laboratory for Experimental Medicine and Pediatrics, University of Antwerp, Belgium
    • Department of Nephrology-Hypertension, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem/Antwerpen, Belgium.
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  • No conflict of interest was declared.

Abstract

Purpose

To count in the Belgian ambulatory prescription database Pharmanet, the number of elderly people treated with ACE inhibitors (ACEI) and/or angiotensine receptor blockers (ARB) (±diuretics ± β-blockers) who eventually also received a prescription of non-steroidal anti-inflammatory drugs (NSAID) or spironolactone.

Method

All prescriptions dispensed in community pharmacies are collected in the Pharmanet database. The data of 2005 were used. Two age groups were studied: 65–79 years (label 1) and 80+ years (label 2). The following chronic treatments (subgroups) were studied: (A) ACEI/ARB; (B) ACEI/ARB + diuretics; (C) ACEI/ARB + spironolactone; (D) ACEI/ARB + β-blocker + diuretic and (E) ACEI/ARB + β-blocker + spironolactone.

Results

In 2005, 7.3% of Belgian population was chronically treated with ACEI/ARB. Twenty-five per cent of 65–79 year-old-patients (subgroup A1) and 36.15% of 80+ year-old-patients (subgroup A2) received ACEI/ARB. At least one package of NSAID or spironolactone was prescribed to subgroup A1 in 25.44 and 5.80%, respectively, and to subgroup A2 in 22.04 and 9.89%, respectively. In all studied subgroups and age categories, NSAID were coprecribed in more than 20–35% of cases.

Conclusions

NSAID are frequently prescribed in elderly patients treated with ACEI or ARB in combination with diuretics. Severe renal adverse effects may result in this high-risk population. Copyright © 2008 John Wiley & Sons, Ltd.

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