As a pharmacist, you will see more focus on the kidney risks of non-steroidal anti-inflammatory drugs (NSAIDs). Some government and medical groups are now educating providers to avoid giving NSAIDs to patients at risk for kidney problems.
Think about a patient's risk before suggesting an NSAID. It's usually okay for patients with good renal function to use NSAIDs or for higher-risk patients to use daily low-dose aspirin, topical NSAIDs, or occasional OTC doses of oral NSAIDs. Caution about using higher or more frequent NSAID doses in patients at risk for kidney injury due to heart failure, diabetes, liver or existing kidney disease, or those on a diuretic, ACEI, or ARB.
Suggest alternatives like acetaminophen, topical agents, tramadol, etc. If an NSAID is started in a high-risk patient, suggest monitoring kidney function and serum potassium within the first week. If these patients develop an acute viral illness, advise them to drink fluids to prevent dehydration. Recommend holding the diuretic and the ACEI or ARB if the patient becomes dehydrated or develops orthostatic hypotension. Advise immediate medical care if a patient develops signs of kidney problems like edema, low urine output, confusion, nausea, etc.
References
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Lapi, F., Azoulay, L., Yin, H., Nessim, S.J. and Suissa, S. (2013). Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study. BMJ, 346(jan08 12), pp.e8525–e8525. Available at: https://www.bmj.com/content/346/bmj.e8525
KK, L. (2005). Drug combinations and impaired renal function - the “triple whammy”. [online] europepmc.org/. Available at: http://europepmc.org/article/MED/15676048
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