Drug Interactions and Monitoring in Elderly Patients with Hypertension, Diabetes, and Impaired Renal Function

Critical Drug-Drug Interactions to Avoid

• The American Geriatrics Society warns about using trimethoprim-sulfamethoxazole with ACE inhibitors or ARBs in patients with reduced kidney function due to increased hyperkalemia risk 1

Interactions with Other Medications

• The European Society of Cardiology notes that aspirin can worsen renal function in patients with chronic kidney disease or those taking nephrotoxic drugs 2
• The European Society of Cardiology cautions against combining anticoagulants with NSAIDs, which may be co-prescribed with diuretics 2

Special Considerations for Elderly Patients with Diabetes and Renal Impairment

• The American Geriatrics Society expanded recommendations to avoid concurrent use of medications that increase serum potassium with furosemide, as the diuretic causes hypokalemia while other medications increase potassium 1
• The European Society of Cardiology notes that potassium-sparing diuretics combined with ACE inhibitors or NSAIDs cause hyperkalaemia more frequently in elderly patients 3

Renal Function Monitoring

• The European Society of Cardiology recommends using the CKD-EPI equation for estimating glomerular filtration rate in older adults, as creatinine-based equations may misclassify kidney disease in over 30% of elderly patients due to reduced muscle mass 4
• Renal function should be monitored at least yearly, but more frequently in elderly patients, those with baseline renal impairment, or those on concomitant medications affecting renal function, according to guidelines from the European Heart Journal 2 and the Journal of Thrombosis and Haemostasis 5