Abstract
The combination of a renin−angiotensin-system inhibitor, a diuretic, and a nonsteroidal anti-inflammatory drug (NSAID), also known as “Triple Whammy,” has been reported to increase the risk of acute kidney injury (AKI). Triple Whammy drugs are often prescribed by multiple physicians. Therefore, interventions by community pharmacists are important to prevent AKI. In 2018, we started an educational campaign in Shiga Prefecture to raise awareness about the risk of AKI due to Triple Whammy among community pharmacists by providing examples of how to respond to Triple Whammy. This study aimed to evaluate the campaign using a questionnaire survey over four years. Four surveys were conducted from 2018 to 2022, and we found that before the campaign, the awareness of the risk of AKI due to Triple Whammy was 30.0％, with no pharmacists inquiring about it. However, after the campaign started, the awareness increased to > 80％ and continued to increase over time. The percentage of pharmacists with inquiries also increased to 18.8％. Additionally, 38.0％ of pharmacists had experience in teaching patients about Triple Whammy, and 15.0％ of pharmacists had experience in teaching patients about caution or discontinuation of NSAIDs as over-the-counter drugs for Triple Whammy. In conclusion, the awareness of Triple Whammy and the number of pharmacists with experience in making inquiries markedly increased after the educational campaign, indicating the success of the campaign. The continuation of the campaign is expected to improve patient adherence and contribute to AKI prevention and early detection.
