Over 22,000 New Zealanders at risk of kidney harm because of medicine ‘triple whammy’

Over 22,000 New Zealanders aged 65 and
over are taking a potentially dangerous
combination of medicines that could
seriously damage their kidneys. Known as
the ‘triple whammy’, the risk comes when
medicines for heart failure or blood pressure,
water tablets and pain relief/antiinflammatory
medicines are taken together.
The Health Quality & Safety Commission’s
Atlas of Healthcare Variation shows over 22,000
New Zealanders aged 65 and over are taking
this combination of medicines each year.
The Commission, in partnership with ACC,
is highlighting the risk of this combination as
part of Patient Safety Week, 5–11 November 2017.
In the latest update to the Atlas of Healthcare
Variation: polypharmacy domain, the triple
whammy is included for the first time.
This shows between 2014 and 2016, the
triple whammy was supplied on average
23,300 times per year to patients aged 65 and over.
Health Quality & Safety Commission
Medication Safety Clinical Lead Dr Alan
Davis says the risk often arises when people
who are taking heart failure or blood
pressure medicines and diuretics (water
tablets) then start on a non-steroidal antiinflammatory
(NSAID) painkiller.
“The ‘triple whammy’ is when you take the
three types of medicines together. Some of
the medicines used to treat pain and swelling
are available on prescription, and others are
available to buy from pharmacies and
supermarkets. Used together,the combination of
medicines can cause significant harm.
They are involved in morethan half of reported
cases of treatmentrelated
acute kidney failure,” says Dr Davis.
Dr Davis says it is important people taking
these medicines together visit their health
professional to discuss and review their medicines.
New Zealand’s Centre for Adverse Reaction
Monitoring (CARM) received 119 reports of
kidney adverse reactions from January 2000
to December 2012 that were associated with
the use of pain relief or anti-inflammatory
medicines. These included four deaths, and
12 cases that were considered lifethreatening.
Most of the reports were in
adults over 50 years of age.
Dr Davis says health professionals are
advised not to supply the combination of the
three medicines to people with risk factors for
kidney failure – such as older adults, people
with some kidney failure already, people at
risk of dehydration (vomiting, diarrhoea,
inadequate fluid intake), and hypotensive patients.
‘Heart and blood pressure medication and
pain relief medication affect blood flow in
the kidneys, while diuretics can cause
dehydration, which can also affect kidney function.’
He says it is important people taking heart/
blood pressure medicines and diuretics do
not also take over-the-counter non-steroidal
(NSAID) pain relief medicines.
Between 2011 and 2016, ACC accepted over
5,800 Treatment Injury claims related to
medication errors and reactions. ACC’s
Chief Clinical Advisor Peter Robinson says
while many of these injuries are minor, a
small number are severe, with long-term
effects on patients, and are a priority for
ACC to prevent.