A cross-sectional exploratory survey on occurrence of triple-whammy prescription pattern in Japan
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SHORT RESEARCH REPORT
A cross‑sectional exploratory survey on occurrence of triple‑whammy prescription pattern in Japan Shungo Imai1 · Kenji Momo2 · Hitoshi Kashiwagi1 · Takayuki Miyai3 · Mitsuru Sugawara1,4 · Yoh Takekuma4 Received: 22 March 2020 / Accepted: 18 June 2020 © Springer Nature Switzerland AG 2020
Abstract Background The concurrent use of nonsteroidal anti-inflammatory drugs, renin–angiotensin–aldosterone system blockers, and diuretics, known as a “triple-whammy,” is related to the occurrence of acute kidney injury. However, there are few reports regarding the prescription pattern of the triple-whammy. Objective To elucidate the patterns of the triple-whammy prescription in Japan. Methods A cross-sectional study was performed using a health-insurance-claims database that included Japanese people under 75 years of age, and enrolled outpatients that were prescribed any nonsteroidal anti-inflammatory drugs, renin–angiotensin–aldosterone system blockers, and diuretics between April 2017 and June 2017. As an outcome, the proportion of triple-whammy prescriptions was evaluated. Among the patients who received triple-whammy prescriptions, we evaluated the prevalence of chronic kidney disease and the proportion of prescriptions provided for these three drugs from different clinical departments and institutions. Results Overall, 730 of 246,721 (0.3%) patients received triple-whammy prescriptions. Among these patients, 13.3% had underlying chronic kidney disease. The proportions of any of the three drug types prescribed by different clinical departments and institutions was 48.2% and 61.8%, respectively. Conclusions We examined the patterns of triple-whammy prescriptions and concluded that pharmacists need to pay attention to triple-whammy prescriptions if the prescriptions are provided by multiple clinical departments or institutions. Keywords Acute kidney injury · Insurance claims · Japan · Triple-whammy prescriptions
Impacts on Practice • To avoid acute kidney injury, clinicians and pharmaElectronic supplementary material The online version of this article (https://doi.org/10.1007/s11096-020-01088-z) contains supplementary material, which is available to authorized users. * Yoh Takekuma y‑[email protected] 1
Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12‑jo, Nishi 6‑chome, Kita‑ku, Sapporo 060‑0812, Japan
2
Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, 1‑5‑8 Hatanodai, Shinagawa‑ku, Tokyo 142‑8555, Japan
3
Graduate School of Life Science, Hokkaido University, Kita 10‑jo, Nishi 8‑chome, Kita‑ku, Sapporo 060‑0810, Japan
4
Department of Pharmacy, Hokkaido University Hospital, Kita 14‑jo, Nishi 5‑chome, Kita‑ku, Sapporo 060‑8648, Japan
cists should be aware of “triple-whammy” prescriptions (i.e., concomitant use of nonsteroidal anti-inflammatory drugs, renin–angiotensin–aldosterone system blockers, and diuretics) because 0.3% of Japanese patients under 75 years of age who were prescribed any of these drugs received triple-whammy presc
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