Major
Ibuprofen × Losartan
Non-steroidal anti-inflammatory drugs (NSAIDs)×Angiotensin II receptor blockers (sartans)
Mechanism
NSAIDs reduce renal blood flow via prostaglandin blockade. The ARB (losartan) lowers glomerular pressure. The combination causes acute kidney injury, especially in older patients, chronic kidney disease, and dehydration.
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 ibuprofen is needed for a short course, use the minimum effective dose for 5–7 days with pantoprazole cover and creatinine monitoring. For chronic analgesia: paracetamol or celecoxib.