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NSAID renal risk triple whammy — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsNSAID renal risk triple whammyGPhC CRA

A 70-year-old man taking ramipril 10mg daily and bendroflumethiazide 2.5mg daily asks to buy naproxen for acute back pain. His records show CKD stage 3 and eGFR 42mL/min/1.73m2. He had diarrhoea yesterday. What is the most important interaction to flag?

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Correct answer: E — Naproxen with ramipril and diuretic increases acute kidney injury risk

The combination of an NSAID, ACE inhibitor and diuretic can precipitate acute kidney injury, particularly in CKD or dehydration. Recent diarrhoea increases this risk further. The pharmacist should advise against OTC naproxen and suggest safer analgesia or medical review depending on symptoms. Gastroprotection would not address the renal interaction.

Reference: BNF NSAID interactions; NICE CKS NSAIDs