Reacción a "Reactions: EMA recommends that codeine-ibuprofen combination medicines warn of possible serious harm"

Ibuprofen is a drug belonging to the group of non-steroidal anti-inflammatory drugs (NSAIDs) that is commonly prescribed to treat pain and inflammation and, among its complications, in addition to the more well-known lesions in the gastrointestinal tract, there is a risk of acute kidney injury (AKI) that can cause from a mild loss of renal function to severe renal failure, which may require renal replacement therapy with dialysis for the patient. This AKI has little clinical expression, which may lead to a delay in diagnosis. Therefore, the recommendation of the European Medicines Agency (EMA) to include a new warning in the label and package leaflets of analgesic drugs containing a fixed-dose combination of codeine and ibuprofen seems appropriate. 

NSAIDs can cause various renal disorders (interstitial nephritis, nephrotic syndrome, papillary necrosis, etc.). Pre-renal AKI, which can lead to acute tubular necrosis (ATN), is the most frequent and relevant. The mechanism is inhibition of renal prostaglandin production, limiting dilatation of renal afferent vessels and thus renal perfusion.

There are risk factors for NSAID-induced AKI such as Chronic Kidney Disease (CKD), especially stage 3-5 CKD of any aetiology (glomerular filtration rate <60 ml/min), states of effective circulating hypovolaemia (dehydration, heart failure, cirrhosis, etc), advanced age, treatment with angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor antagonists (ARBs) that limit the constriction of efferent renal vessels, and concomitant use of other nephrotoxic drugs. Therefore, in patients at renal risk, their use should be avoided to prevent NSAID-induced AKI. It is important to inform patients of the risk, avoid chronic use of this drug as well as concomitant nephrotoxic drugs and dehydration.