Nihal (age 58) came to my clinic last week feeling very anxious and tired. He had no history of kidney disease, but blood tests showed that both of his kidneys were failing very quickly.
"Dr. Priya, I usually take Losartan and a diuretic daily, which the doctor prescribed for high blood pressure and heart disease. Recently, due to severe pain in my shoulder, I bought Diclofenac tablets from a pharmacy without a doctor's prescription and continued to take them for several weeks. Now both my legs are swollen and I have difficulty breathing," Nihal explained.
I calmly told Nihal, "Nihal, you have unknowingly made a very dangerous mistake. By taking this painkiller like diclofenac along with the blood pressure pills and water pills that you are taking, the blood flow to the kidneys is almost completely stopped. In medicine, we call this a triple whammy . This has caused severe damage to your kidneys. Let's talk about this simply today so that everyone is aware."
๐จ Red Flags of Kidney Failure That Should Prompt Medical Treatment
If you experience the following symptoms while using painkillers without a doctor's prescription, you should seek immediate medical attention as it could be a sign of kidney failure:
- Sudden swelling of the legs, ankles, feet, or face (Fluid Retention).
- Severe shortness of breath without an obvious cause.
- Feeling unusually tired, lethargic, or lifeless.
- A sudden decrease in the amount of urine output to a very low level (or no urine output at all).
The silent danger of NSAID painkillers
Many people in Sri Lanka purchase NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) directly from pharmacies when they experience a body ache, headache, or muscle pain.
The main examples are:
- Diclofenac
- Aspirin
- Ibuprofen
- Mefenamic Acid / Ponstan
Although these drugs may temporarily relieve pain, continued use can permanently impair kidney function. The risk is particularly high when these drugs are taken with other medications used for blood pressure and heart disease.
What is the "Triple Whammy" of kidney failure?
Patients being treated for high blood pressure and heart disease can unknowingly use the following three classes of drugs together, completely disabling the kidney's filtration process. This is known in medical terms as the "Triple Whammy":
1.ACE inhibitors or ARBs: Medicines such as Captopril , Enalapril , or Losartan, which doctors prescribe to lower blood pressure, widen the efferent arterioles that carry blood away from the kidneys and reduce pressure inside the kidneys.
2. Diuretics (water pills): Medications that help the body eliminate excess salt and water through urine, which reduces the amount of blood flowing to the kidneys.
3. NSAID painkillers (Diclofenac/Aspirin): These painkillers block the production of prostaglandins, which help dilate blood vessels in the kidneys. This causes the afferent arterioles to narrow significantly.
When all three of these actions occur simultaneously, the amount of blood flowing to the kidney drops dramatically, filtration pressure is lost, and acute kidney injury (AKI) occurs.
The risk of buying medicines at pharmacies on impulse
Pharmacies are staffed by pharmacists, not doctors who can diagnose diseases. Since they don't know what long-term medications you are currently taking, giving you the painkillers you ask for can cause deadly drug interactions like these.
Many people in Sri Lanka use even simple painkillers for long periods of time without any understanding of their serious side effects.
Do's & Don'ts
| โ๏ธ Things to do (Do) | โ Don'ts |
|---|---|
| If you take blood pressure pills or water pills, ask your doctor for advice and only use a safe medicine like paracetamol in case of pain. | Do not buy painkillers such as diclofenac, ibuprofen, or aspirin directly from pharmacies and continue to take them without a doctor's prescription. |
| Get a simple blood test (Serum Creatinine/eGFR) at least once a year to check kidney function. | Never use NSAID painkillers when you have a fever or are dehydrated. |
| Present details of all long-term medications you are taking to your doctor every time you see him. | Since kidney damage may not show symptoms in the early stages, don't wait until you feel unwell to seek medical attention. |
โ Some other questions you may have (FAQ)
Which patients are at risk for the "Triple Whammy"? โผ
This risk is particularly high in patients who are taking ACE inhibitors/ARBs and diuretics (water pills) for high blood pressure, heart disease, or kidney failure, and who are also taking painkillers (NSAIDs).
Do I need dialysis if I have kidney failure due to painkillers? โผ
If acute kidney injury occurs, dialysis may be required temporarily to control the toxins in the body. Often, with immediate discontinuation of painkillers and proper medical treatment, the kidneys can recover within a few weeks.
Does using Paracetamol also cause kidney damage? โผ
No, paracetamol is completely safe for the kidneys when taken in the recommended dosage (not exceeding 4g per day). Since paracetamol is not an NSAID, it does not interfere with blood flow to the kidneys.
What are the "Sick Day Rules"? โผ
On days when you experience severe diarrhea, vomiting, or high fever and become dehydrated, medications such as ACE inhibitors, ARBs, diuretics, and NSAIDs should be temporarily stopped for a few days under medical advice to protect the kidneys, as blood flow to the kidneys is reduced.
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