beware-of-triple-whammy

Abstract

The term "triple whammy" refers to a drug interaction following the concurrent use of angiotensinconverting enzyme inhibitors or angiotensin-II receptor blockers, diuretics and non-steroidal antiinflammatory drugs, the combination of which greatly increases the odds of acute kidney injury.Here, we report a case of a 66-year-old gentleman who was admitted into a tertiary care hospital for elective orthopaedic intervention. He had previously been prescribed sacubitril/valsartan and frusemide and had newly been started on celecoxib during hospitalisation. Upon the initiation of celecoxib, a mild increase in his serum creatinine was immediately observed, and this occurrence is believed to be due to the "triple whammy" combination. The combination of perindopril, frusemide and celecoxib continued to be overlooked throughout his hospitalisation. He was subsequently planned to be discharged with celecoxib on top of his existing chronic medications. However, upon discharge, the dispensing pharmacist took notice of the drug interaction and successfully intervened to withhold celecoxib.

Self-induced Anuria with Diclofenac: An Interesting Case of “Quadruple Whammy” Acute Kidney Injury

“…The term "triple whammy" was first introduced by Merlin C. Thomas in 2000, and refers to the simultaneous use of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), diuretics, and NSAIDs, or selective cox-2 inhibitors [14][15][16][17].…”

“…Several studies have assessed the risk of AKI after a triple whammy, showing that the highest risk occurs within the first 30 days and then decreases [14][15][16][17][18][19][20]. Only a 2022 Japanese study reported the time to onset of AKI [18].…”