The combination of angiotensin converting enzyme inhibitors, diuretics and non-steroidal anti-inflammatory drugs in the routine community pharmacy settings in Poland: The unrecognized problem of ‘Triple Whammy’. A pilot analysis.
Journal Title: JOURNAL OF HEALTH POLICY & OUTCOMES RESEARCH - Year 2018, Vol 1, Issue 1
Abstract
Background: ‘Triple Whammy’ defined as a combination of angiotensin converting enzyme inhibitors/angiotensin receptor antagonist, diuretics and non-steroidal anti-inflammatory drugs remains an important clinical problem, particularly in patients with risk of renal impairment. Community pharmacy settings are considered to be an appropriate place for detection and solving of this drug-related problem. Objectives: To estimate the frequency of ‘Triple Whammy’ in a routine community pharmacy setting in Poland by analysis of data obtained from refilled prescriptions. Methods: We conducted anon-interventional, observational retrospective study to assess the rate of ‘Triple Whammy” cases in a community pharmacy setting in Poland. We reviewed 14243 prescriptions to find ‘Triple Whammy’ cases. The analyzed prescriptions were refilled between the 1.01.2016 and 31.05.2016 in one single community pharmacy in Poland. Results: The average age of all patients identified with ‘Triple Whammy’ was 68 (range, 56-91). We identified 12 prescriptions with ‘Triple Whammy’ among all cases, receiving most frequently ramipril (n=8 patients), diclofenac (n=6) and ketoprofen (n=5). Moreover, other medications that were prescribed to patients during the study analysis time period included proton pump inhibitors such as pantoprazole (n=3) and omeprazole (n=2), opioid analgesics – tramadol (n=1) in the fixed-dose combination with paracetamol, and one antihyperglycemic medication – metformin (n=1). Conclusions: ‘Triple Whammy’ should be considered as a potential drug-related problem in Poland. Our study suggests that geriatric population is particularly affected by this drug-related problem, and, consequently, pharmaceutical care is predominantly necessary among this cohort.
Authors and Affiliations
Magdalena Piekarska, Damian Świeczkowski, Tomasz Haręźlak, Jerzy Krysiński, Natalia Cwalina, Szymon Zdanowski, Miłosz Jaguszewski, Piotr Merks
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