Drug Interactions in Geriatric Patients: An Evidence-Based Review of the Combination of Antihypertensives and Non-Steroidal Anti-Inflammatory Drugs / Interaksi Obat Pada Pasien Geriatri: Kajian Berbasis Evidence Tentang Kombinasi Antihipertensi dan Obat Non Steroidal Anti-Inflammatory

The number of elderly individuals continues to increase globally, accompanied by a high prevalence of chronic diseases, particularly hypertension and musculoskeletal disorders. This condition makes geriatric patients vulnerable to polypharmacy, which increases the risk of drug interactions, one of which is between antihypertensives and non-steroidal anti-inflammatory drugs (NSAIDs). Such interactions can potentially reduce therapy effectiveness, cause electrolyte disturbances, and lead to acute kidney injury (AKI). This study aims to comprehensively examine the interaction between antihypertensives and NSAIDs in geriatric patients and its impact on therapy safety. The method used is a literature review by selecting national and international articles published between 2015 and 2025, written in either Indonesian or English, specifically investigating interactions between antihypertensives (β-blockers, ACE inhibitors, ARBs, diuretics, and CCBs) and NSAIDs. The review results indicate that most interactions are pharmacodynamic, involving either antagonism or negative synergism. NSAIDs can reduce the effectiveness of antihypertensive therapy through mechanisms such as sodium retention, afferent arteriolar vasoconstriction, and decreased renal perfusion. In certain combinations, such as the triple whammy phenomenon (NSAIDs, diuretics, and RAAS inhibitors), the risk of AKI and hyperkalemia increases significantly. This risk is higher in geriatric patients with decreased kidney function, comorbidities, and concurrent use of multiple drugs. In conclusion, the interaction between antihypertensives and NSAIDs in the elderly population is an important clinical issue. Therefore, close monitoring of kidney function and electrolytes, using the lowest effective dose for the shortest possible duration, and patient education to avoid self-medication are necessary to ensure therapy safety.

Jumlah penduduk lanjut usia terus meningkat secara global dan diikuti dengan tingginya prevalensi penyakit kronis, terutama hipertensi dan penyakit muskuloskeletal. Kondisi ini menyebabkan pasien geriatri rentan mengalami polifarmasi yang meningkatkan risiko interaksi obat, salah satunya antara antihipertensi dan non-steroidal anti-inflammatory drugs (NSAID). Interaksi tersebut berpotensi menurunkan efektivitas terapi, menimbulkan gangguan elektrolit, hingga menyebabkan acute kidney injury (AKI). Penelitian ini bertujuan untuk mengkaji secara komprehensif interaksi antara antihipertensi dan NSAID pada pasien geriatri serta dampaknya terhadap keselamatan terapi. Metode yang digunakan adalah literature review dengan menyeleksi artikel nasional dan internasional yang diterbitkan dalam kurun waktu 2015–2025, menggunakan bahasa Indonesia maupun Inggris, dan secara khusus meneliti interaksi antihipertensi (β-blocker, ACE inhibitor, ARB, diuretik, dan CCB) dengan NSAID. Hasil kajian menunjukkan bahwa sebagian besar interaksi bersifat farmakodinamik, baik antagonisme maupun sinergisme negatif. NSAID dapat menurunkan efektivitas terapi antihipertensi melalui mekanisme retensi natrium, vasokonstriksi arteriol aferen, serta penurunan perfusi ginjal. Pada kombinasi tertentu, seperti fenomena triple whammy (NSAID, diuretik, dan RAAS inhibitor), risiko AKI dan hiperkalemia meningkat secara signifikan. Risiko ini lebih tinggi pada pasien geriatri dengan fungsi ginjal yang menurun, komorbiditas, serta penggunaan banyak obat secara bersamaan. Kesimpulannya, interaksi antara antihipertensi dan NSAID pada populasi lanjut usia merupakan masalah klinis yang penting, sehingga diperlukan pemantauan ketat fungsi ginjal dan elektrolit, penggunaan dosis efektif terendah dengan durasi sesingkat mungkin, serta edukasi pasien untuk menghindari swamedikasi guna menjaga keselamatan terapi.