Major
Candesartan × Diclofenac
Angiotensin II receptor blocker×Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism
Similar to ibuprofen + losartan. Diclofenac has a high nephrotoxic potential among NSAIDs.
Symptoms
Reduced urine output, rising creatinine and potassium, oedema. Symptoms appear earlier in older patients and in chronic kidney disease.
Management
Avoid prolonged combination. If diclofenac is needed for a short course, use the minimum effective dose for 5–7 days with creatinine monitoring. For chronic analgesia: paracetamol or celecoxib.