This is a fairly involved story. I will try to keep it short.
At the beginning of June my 87-year-old father developed severe hip pain. He was diagnosed with bursitis and was prescribed a Vicodin equivalent (10 mg hydrocodone/325 mg acetaminophen) to be taken four times a day. At the same time, I began giving him 600 mg of ibuprofen (i.e. prescription strength) four times a day (I informed his doctors of this more than once). In addition to this, he continued with his prescriptions of 12.5 mg of lisinopril (a blood pressure med), 20 mg of omeprazole (an acid reflux med) and 81 mg of aspirin, each daily.
After about a month of this, my father’s kidneys shut down. He was diagnosed with acute kidney injury and hospitalized. The doctor who discharged him told me, “If I were on those drugs for a month, I’d be in kidney failure.” He explained that a combination of ibuprofen and lisinopril can be particularly hard on the kidneys.
I complained to my dad’s HMO about this. They took it as a formal grievance, and in their written response they said about the ibuprofen, “It would be difficult to predict that a patient may not tolerate it and experience adverse effects.” Their response didn’t address the question of the combination of drugs.
I’d like the opinions of the medical experts here: was this combination of drugs particularly risky, or was it just a case of bad luck? I’m especially interested in the interaction of lisinopril with prescription-strength ibuprofen.
My dad is fine, by the way. His kidney function returned to normal in about a week and a half after discontinuing his medications and consuming lots of fluids.
I don’t have any actual information and I don’t take lisipronil. I would suggest you get a second opinion by checking with your own doctor or pharmacist. If there’s a known bad interaction between the two, I would think it ought to be known to other medical professionals, especially given how common ibuprofen is.
The NSAID (ibuprofen, acetaminophen) are kidney killers. I don’t know about aspirin and kidneys.
I have Stage III CKD (aka kidney failure) and the #1 (with bullet) rule is NO NSAIDs.
And it is almost always a bad idea to mix OTC and script pain meds.
The old rules, whereby hydrocodone (Sch II narcotic) became a Sch III (able to be refilled, called/faxed in, etc.) when mixed with an NSAID are gone - you now need to jump through the same hoops to get Vicodin et. al. as to get morphine.
No reason to use hydrocodone if it it no longer works.
You may have an MD who will not write script for anything stronger. If required, find a MD who will.
If you go to WebMd and use their drug interaction checker you will see there is a possibility of serious problems and that your doctor should monitor for problems. So it seems probable that your HMO is wrong.
How exactly do you do this? What is the code for "not a drug seeker or junkie, elderly person with serious issue deserving of the drug’?
Went through the same thing with my mom with stage four cancer, no one wanted to RX opiates even though she was in excruciating pain. Hell her oncologist who spoke broken English told her something about no these drugs are bad and illegal and addictive like marijuana or cocaine when I told her to point blank ask, and my mom wasn’t really all there mentally so that just freaked her out and got her worried. She was angry at me for getting her to ask, she was worried she was going to get in trouble or arrested(like I said she wasn’t all there).
Eventually no doctor was willing, they referred her to a pain management clinic with terms she couldn’t meet like random drug testing where if they called she had to show up within an hour and pee. She also freaked out about all the prove you’re not a drug addict hoops.
I actually mailed her some OTC for me low dose codeine aceto combo tablets which helped a little, the whole thing was ridiculous and made a hard situation worse.
When the surgeon who was going to do her surgery told her it was not going to happen and he was told he RXed her morphine tablets, my sis said first thing she asked him when he asked if she had questions was “am I going to be a drug addict?” my sis said she was like :smack:
Anyway sorry for the highjack but suffice to say the treatment of pain seems to be broken, and the media claims a tsunami of opiates hits the streets from doctors offices somehow.
EDIT:BTW the broken english thing is not a dog whistle, the doctors poor communication combined with my mom’s poor understanding made things worse.
My understanding of ‘OTC analgesic’ v ‘NSAID’ may be somewhat confused. Sorry if my list was inaccurate.
Maybe search for “drug name + kidney” to see if any specific drug has renal implications.
I do not understand the exact mechanism of the kidney problems, so it may be only blood thinners or some such action cause problems.
For finding Sch II - frankly, this is going to be an age/race/income/sex issue. Yes, I will get a new one ripped, but there it is.
My approached has been to ask for ‘an Internist who does not have a problem with dispensing controlled substances’.
I am an old white guy with advanced education and a medical record of long-term issues with all kinds of dangerous drugs.
I calmly explain that I have very high tolerance for all forms of CNS depressants. The last anesthesiologist who had me stopped by my room post-op and explained that he had had a hell of a time keeping me down. I just pointed out that I had warned him in our pre-op chat.
(Traditionally, women have had more difficulty getting (esp male) docs to take their pain seriously. Gawd knows how/why)
It is extremely difficult to keep up with medication interactions with someone who’s taking multiple medications. (I take a handful of meds daily for asthma, migraine, allergies, and inflammatory arthritis, so I can sympathize.) And physicians often don’t know what will happen when a patient takes multiple drugs. I’d suggest also reporting this issue to the FDA.
An underutilized resource is your pharmacist. If you have questions in the future, take the list of medications your father is taking to your pharmacist, and ask if you should be notify the doctor about any problems.
It sucks that your father’s physician didn’t catch this.
I’m sorry this happened to your father.
I’ve heard this as well. I’ve never had this problem, and have chronic migraine. I suspect it can also be an income/educational level issue. My docs know my educational background (more than one asked me if I work in the medical profession), so they may take me more seriously. It may also help that I’m matter-of-fact, not emotional when I describe the pain and condition.
Anyway, I always recommend anyone with chronic pain issues to work with a pain management team and/or hospice (whichever is appropriate).
Oh, and I don’t give a damn if junkies take opiates. I get that doctors don’t want their prescriptions diverted to junkies, but dammit, I’d rather we have an uptick in idiots snorting oxycontin than one innocent person have to live in pain because the feds are worried about the idiots more than the innocents in pain.
