It’s wrong to combine hypertensive drugs with other medications, pharmacists tell patients

In order to prevent serious side effects and treatment failure, chemists have urged patients with diabetes, hypertension, and other cardiovascular problems not to take their regular prescriptions with other medications.

The warning was issued by chemists with extensive knowledge of drug interactions, who pointed out that the intricate interactions between the medications used to treat certain disorders may result in negative drug reactions, highlighting the necessity of close observation and individualised treatment regimens.

In order to prevent negative interactions that could exacerbate side effects and treatment results, the drug information specialists emphasised the importance of closely monitoring prescription regimens.

Although they acknowledged the prevalence of diabetes and hypertension, they cautioned that certain drug combinations may raise the risk of serious adverse effects, toxicity, and even death.

The chemists also observed 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 pointed out that drugs like corticosteroids, which are frequently recommended to treat inflammation or other ailments, may raise blood sugar levels, making it harder for diabetics to maintain acceptable glucose levels.

The effects of a medicine combination may be especially concerning for those who are already using insulin or other oral diabetic treatments, according to Obube, a member of the Ogun State medicine Control Committee. This is because the combination may necessitate close monitoring and potential dose adjustments.

The chemist noted that it could be challenging to combine blood pressure medicine with diabetes therapies, but emphasised that blood pressure control was crucial to lowering the risk of cardiovascular issues for diabetic patients.

According to him, some drugs, like steroids and some diuretics, could increase 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 underlined that NSAIDs presented an extra danger by compromising renal function, which is already a concern for people using antihypertensive drugs.

He pointed out that this combination may result in a hazardous downward spiral that compromises the health of the heart and kidneys.

Blood pressure can become dangerously low or increased when blood pressure-lowering drugs (such as beta-blockers, ACE inhibitors, and ARBs) are taken with other blood pressure-lowering drugs, such as NSAIDs or some antidepressants.

Although diuretics are frequently used to treat hypertension, they can deplete vital electrolytes like potassium. There is an increased risk of arrhythmias and muscle problems when taken with other drugs that can alter electrolytes, such as corticosteroids and some antibiotics.

ARBs and ACE inhibitors, which are frequently prescribed for hypertension, can affect renal function. These in conjunction 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.
Lower dosages or other medications may be required to prevent toxicity in patients with compromised liver or kidney function. Organ harm can result from combinations that put additional burden on certain organs, such as paracetamol and alcohol in liver illness.

Electrolyte abnormalities, especially elevated potassium, are a risk for individuals with kidney disease. When potassium-raising medications (like some diuretics) are taken with potassium-sparing medications (like ACE inhibitors), the result can be dangerously elevated potassium levels that can cause heart problems.

The chemist went on to say that some drugs, such as antidepressants and some antibiotics (such as macrolides like erythromycin), might cause arrhythmias by lengthening the QT interval on an ECG.

"Those who already have heart issues are at an increased danger. Blood thinners, such as aspirin and warfarin, are taken by many persons with heart problems. These can raise the risk of bleeding, particularly in the gastrointestinal tract, when used with NSAIDs, certain antibiotics, or SSRIs.

"Medications like NSAIDs can exacerbate heart problems including heart failure by causing fluid retention. This is particularly dangerous because it may negate the effectiveness of medications used to treat heart failure, such as beta-blockers or diuretics.

In order to control blood pressure and avoid cardiac strain, patients with heart disease frequently take several drugs. These drugs may interact with drugs that either raise blood pressure (like decongestants) or lower it (like nitrates), which could result in hypotension or hypertension.

Because of these dangers, people with certain pre-existing diseases should be closely monitored and have customised prescription regimens, which are frequently modified in response to routine evaluations and test findings. To prevent negative relationships and handle these complicated circumstances successfully, speaking with healthcare professionals is crucial.

Tunde Adekola, a chemist at the Lagos State University Teaching Hospital, voiced his worries about the long-term effects of polypharmacy—the practice of writing prescriptions for several medications for various ailments.

According to Adekola, the likelihood of drug-drug interactions increased with the number of medications used.

The stakes are significantly higher for those who have both diabetes and hypertension, he said. Overlapping medication regimens are frequently necessary for both illnesses, and they may interact in ways that initially appear insignificant 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.
Additionally, patients should enquire about potential drug interactions, especially if they are currently taking care of several chronic illnesses.

As a general rule, patients should never take supplements or over-the-counter medications without first talking to their doctor. For instance, a lot of herbal medicines may have unforeseen consequences if they interfere with prescription drugs or alter the way other drugs are metabolised, he said.

"It is impossible to overestimate the significance of effective communication among healthcare providers," he added. Patients who have several chronic illnesses should make sure that all of their medical professionals are informed on all of their prescriptions, including over-the-counter medications and dietary supplements. By doing this, harmful drug interactions that could otherwise go undetected can be avoided.

When taking drugs together, patients with diabetes and hypertension should be extremely cautious because drug interaction