Pharmacists fault combination of hypertensive medications with other drugs

Patients managing diabetes, hypertension, and other cardiovascular conditions have been urged not to combine their routine medications with other drugs to avoid  severe side effects and treatment failure.

Pharmacists with vast experience in drug interaction who issued the warning noted that the complex interplay between medications used to manage these conditions could lead to adverse drug reactions, emphasising the need for careful monitoring and tailored treatment plans.

Speaking exclusively with PUNCH Healthwise, the drug information specialists stressed that careful management of medication regimens was essential to avoid adverse interactions that could worsen side effects and treatment outcomes.

While noting that diabetes and hypertension were common, they warned that certain drug combinations could increase the risk of severe side effects, toxicity, and even death.

The pharmacists also noted that drug interactions posed a significant threat to public health, particularly for vulnerable populations such as the elderly, children, and pregnant women.

They explained that older people were susceptible to interactions and complications from drug combinations due to age-related changes in drug metabolism, polypharmacy, and underlying health conditions.

The specialists said combining blood thinners with nonsteroidal anti-inflammatory drugs also known as NSAIDs could lead to gastrointestinal bleeding, while certain antidepressants can interact with blood pressure medications, causing potentially life-threatening complications.

On how drug combinations affect pregnant women, the experts said the women might face unique challenges, as certain medications can affect fetal development or interact with other drugs, leading to complications during pregnancy or childbirth.

A pharmacist and the Vice Chairman, Pharmaceutical Society of Nigeria, Ogun State chapter, Olumide Obube, said for people with diabetes, the combination of certain drugs could have a profound effect on blood sugar levels, which could either raise or lower blood glucose to dangerous levels.

He noted that medications like corticosteroids, often prescribed for inflammation or other conditions, could cause a spike in blood sugar levels, making it more challenging for diabetes patients to keep their glucose levels within a safe range.

Obube, who is a member of the Ogun State Drug Control Committee, explained that the effects of drug combination could be particularly concerning for individuals already on insulin or other oral diabetes medications, as the combination may require careful monitoring and possible dose adjustments.

While stressing that controlling blood pressure was essential to reducing the risk of cardiovascular complications for diabetes patients, the pharmacist stated that combining blood pressure medications with diabetes treatments could be tricky.

He said certain medications, such as steroids and certain diuretics, could raise blood sugar levels, making it challenging to manage diabetes.

The drug information specialist explained that a combination of drugs for patients with hypertension could have severe implications for blood pressure control and overall cardiovascular health.

According to him, Patients with high blood pressure are often prescribed ACE inhibitors or ARBs (angiotensin receptor blockers), which help to relax blood vessels and lower blood pressure. However, when these medications are taken alongside NSAIDs, they can become less effective in managing blood pressure, leading to a situation where the patient’s hypertension may spiral out of control.

He emphasised that NSAIDs also posed an additional risk by impairing kidney function, which is already at risk for those on antihypertensive medications.

This combination, he noted, could lead to a dangerous downward spiral where both kidney and heart health are compromised.

“Combining blood pressure medications (e.g., ACE inhibitors, ARBs, beta-blockers) with other medications that affect blood pressure, like NSAIDs or certain antidepressants, can lead to either elevated or dangerously low blood pressure.

“Diuretics are common in hypertension management, but they can deplete essential electrolytes like potassium. When combined with other medications that also affect electrolytes (e.g., corticosteroids, some antibiotics), there’s a higher risk of arrhythmias and muscle issues.

“ACE inhibitors and ARBs, often used for hypertension, can impact kidney function. Combining these with NSAIDs or diuretics (the “triple whammy” effect) can severely compromise kidney function, leading to acute kidney injury,” he explained.

When asked how combining multiple drugs affects the kidney and heart, the pharmacist said, “The kidneys and liver are responsible for metabolising and eliminating many drugs. In kidney or liver disease, drugs may accumulate in the body, raising the risk of toxicity. For instance, drugs like NSAIDs can be particularly harmful to kidneys, and opioids can cause toxicity in liver disease.

“With impaired kidney or liver function, lower drug doses or alternative drugs may be needed to avoid toxicity. Combinations that further strain these organs (e.g., combining acetaminophen with alcohol in liver disease) can lead to organ damage.

“People with kidney disease are at risk for electrolyte disturbances, particularly high potassium. Combining potassium-sparing drugs (e.g., ACE inhibitors) with other potassium-raising agents (e.g., certain diuretics) can lead to dangerously high potassium levels, causing cardiac issues.

Continuing, the pharmacist said certain medications, including some antibiotics (e.g., macrolides like erythromycin) and antidepressants, could prolong the QT interval on an ECG, leading to arrhythmias.

“This risk is heightened for those with pre-existing heart conditions. Many people with heart conditions take blood thinners (e.g., warfarin, aspirin). Combining these with NSAIDs, certain antibiotics, or SSRIs can increase bleeding risk, especially in the gastrointestinal tract.

“Drugs like NSAIDs can cause fluid retention, worsening heart conditions such as heart failure. This is especially risky when combined with drugs that manage heart failure (e.g., beta-blockers or diuretics), as it may counteract their effects.

“Patients with heart disease often take multiple medications to manage blood pressure and prevent strain on the heart. Drugs that either lower (e.g., nitrates) or raise blood pressure (e.g., decongestants) can interfere with these medications, potentially leading to hypotension or hypertension.

“Due to these risks, individuals with these pre-existing conditions should have close monitoring and tailored medication plans, often adjusted based on lab results and regular assessments. Consulting healthcare providers is essential to avoid harmful interactions and effectively manage these complex cases.”

On his part, a pharmacist at the Lagos State University Teaching Hospital, Tunde Adekola expressed concern about the long-term consequences of polypharmacy, which is the practice of prescribing multiple drugs for different conditions.

Adekola noted that the more drugs a person took, the higher the chance of drug-drug interactions.

According to him, for individuals with both hypertension and diabetes, the stakes are even higher. Both conditions often require overlapping drug regimens that can interact in ways that may seem minor at first but can result in significant, compounded risks.

He added, “For older adults, who are disproportionately affected by both diabetes and hypertension, the risk is compounded further. Age-related changes in organ function—such as reduced liver and kidney clearance—mean that older individuals metabolise and excrete drugs more slowly, which increases the likelihood of drug accumulation and subsequent toxicity. This makes careful medication management even more critical for older patients who may be on multiple prescriptions at once.”

The pharmacist urged patients to take a proactive role in understanding the potential interactions between the drugs they are taking.

“The first step is to maintain an up-to-date medication list and to regularly review this list with a pharmacist or healthcare provider, especially when adding a new medication.

“Patients should also ask questions about how different medications might interact with each other, particularly if they are already managing multiple chronic conditions.

“One important rule of thumb is that patients should avoid taking over-the-counter drugs or supplements without first consulting their healthcare provider. Many herbal remedies, for example, can interact with prescription medications and can affect how other drugs are metabolised, leading to unintended effects,” he stated.

He further said, “The importance of clear communication between healthcare providers cannot be overstated. Patients with multiple chronic conditions should ensure that all their healthcare providers are aware of every medication they are taking, including over-the-counter drugs and supplements. This can help avoid dangerous drug interactions that might otherwise go unnoticed.

“Patients with diabetes and hypertension need to exercise extreme caution when combining medications, as the risks of drug interactions can lead to a cascade of health problems.

“By being proactive about understanding their medications, communicating openly with healthcare providers, and seeking guidance from pharmacists, patients can better manage their health conditions and avoid potentially life-threatening complications.

“The goal is not just to manage one condition, but to ensure that treatment for one doesn’t exacerbate another, safeguarding the patient’s overall well-being.”