Interaksi Obat Pada Pasien Geriatri: Kajian Berbasis Evidence Tentang Kombinasi Antihipertensi dan Obat Non Steroidal Anti-Inflammatory
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Abstrak
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.
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