How can NSAID cause fluid retention
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NSAIDs fluid retention mechanism renal prostaglandins sodium official prescribing information
NSAIDs cause fluid retention mainly by reducing renal prostaglandin production.
- NSAIDs inhibit COX-1 and/or COX-2.
- This lowers kidney prostaglandins, especially PGE2 and PGI2.
- Normally, these prostaglandins help maintain renal blood flow and promote sodium excretion, particularly when kidney perfusion is reduced.
- With prostaglandins inhibited, the kidneys reabsorb more sodium and excrete less of it.
- Water follows sodium, expanding extracellular volume, which can cause ankle swelling, weight gain, raised blood pressure, and worsening heart failure.
They can also reduce renal blood flow and GFR in susceptible people, further limiting salt and water excretion. This is more likely in older adults and people with heart failure, chronic kidney disease, cirrhosis, dehydration, or concurrent diuretics plus ACE inhibitors/ARBs. NSAIDs may also blunt the effect of loop and thiazide diuretics.
Drug labeling specifically warns that NSAIDs can produce fluid retention and edema, and should be used cautiously in patients with heart failure or pre-existing fluid retention, as noted in diclofenac prescribing information.
Seek prompt clinical advice if NSAID use is followed by rapidly increasing swelling, shortness of breath, reduced urine output, or sudden weight gain.
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