Learn about the relationship between medications and kidney health and how to prevent adverse effects and toxicity by speaking with your doctors and adjusting your doses
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Dozens of common drugs can cause damage if you’re not careful
Most prescription drugs are excreted by the kidneys. So are many of the medications you buy over the counter. Whether or not you have decreased kidney function, it’s important to speak with your doctors and pharmacist about what medications you’re taking, how much you’re taking and how often you’re taking them. Doses may have to be adjusted to prevent adverse effects, toxicity and increased damage to your kidneys.
Steven Coca, professor of medicine and a nephrologist at the Icahn School of Medicine at Mount Sinai in New York, says you should know your estimated glomerular filtration rate (eGFR), the primary measurement of kidney function, and your urine albumin to creatinine ratio (UACR), a marker of kidney damage. Your eGFR will show up any time your doctor orders standard blood work, which is usually covered by insurance. It’s part of the most basic generic lab work you can get.
Your UACR test, also usually covered by insurance, at least in part, indicates the level of protein in your urine and is normally given once a year to monitor kidney damage for those with kidney disease. The UACR also monitors the kidneys for patients who’ve had type 1 diabetes for five years or more and for patients with type 2 diabetes.
“You ought to know these numbers because chronic kidney disease is one of the strongest risk factors for cardiovascular disease and because many medications that are taken by older people are cleared by the kidneys and can, in some cases, cause harm or worsen preexisting kidney disease,” Coca says.
People who are most vulnerable for medication-induced adverse kidney events include those 65 and older, those with underlying kidney disease, people who are dehydrated, patients with low blood pressure, and those who have comorbid conditions such as diabetes, heart disease or have had heart surgery or transplantation, says Karthik Ramani, a nephrologist at Michigan Medicine at the University of Michigan.
Ramani suggests that prior to taking medications, including over-the-counter and herbal supplements, reach out to a qualified health care provider or pharmacist and do your own research by getting information from verified sources such as the National Kidney Foundation, the American Medical Association, National Institutes of Health and the American Society of Nephrology.
“In certain situations, such as when you may need to undergo chemotherapy treatment that could be lifesaving but could also cause some damage to your kidneys, you may decide to proceed with taking the chemotherapy medication even though it can harm your kidneys. You should discuss this type of a situation with your physician and weigh the benefits against the risks of taking medications,” says Michelle Josephson, M.D., a nephrologist and professor of medicine and surgery at the University of Chicago Department of Medicine and past president of the American Society of Nephrology.
Derek Owen, a clinical pharmacist with the kidney team at the University of Chicago Department of Medicine, warns not to assume that because a medication can be purchased over the counter, it’s harmless. “Many over-the-counter medications have multiple medications in them, so it’s important to always check the label to make sure each ingredient is safe for you to take,” he says.
Here are some of the medications that can affect your kidneys.
1. Common pain medications
What they are: Most over-the-counter (OTC) pain medications, part of a category of drugs called analgesics, fall into two categories — nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. NSAIDs relieve pain, reduce fever and treat some cold symptoms. Their ability to reduce inflammation often make them more effective than acetaminophen, which is used to treat mild-to-moderate pain and to bring down fevers.
Examples: Common OTC nonsteroidals include aspirin (Bayer, Anacin, Bufferin), naproxen (Aleve) and ibuprofen (Advil, Motrin). Prescription NSAIDs are commonly used to treat pain from arthritis, gout, menstrual cramps and headaches. Acetaminophen includes brands such as Tylenol and Actamin.
Some better-known prescription analgesics include codeine, oxycodone, hydrocodone and methadone. Owen says commonly known NSAIDs may include indomethacin, meloxicam and celecoxib.
How they can affect kidneys: NSAIDs are normally safe for occasional use and should be used only as directed. If taken for too long, however, they can do damage by reducing blood flow to the kidneys. If they’re taken when you’re dehydrated or when your blood pressure is low, they can cause acute kidney injury. All OTC pain medications should be taken as directed on the label, but none should be taken for more than 10 days in a row for pain or three days in a row for fever. If symptoms persist, speak with your health care team. Long-term use at high doses can cause chronic kidney damage by reducing blood flow to the kidneys. Owen says that the ibuprofen OTC dose should not exceed 400mg (two of the 200mg pills) every 6 hours. The naproxen OTC dose should not exceed 220mg every 8 hours.
2. Antibiotics
What they are: Antibiotics are medications that kill bacteria that cause infection. They can be taken orally, topically or by injection, though for the most part topical medications have limited effects inside the body, says Owen. Some of the more common infections they fight are strep throat and urinary tract infections. They’re not needed for all infections and should be used only when prescribed by a physician.
Examples: Some of the most common antibiotics include penicillin, amoxicillin, ciprofloxacin, doxycycline and azithromycin.
How they can affect the kidneys: If you have kidney disease, understand what your kidney function is before you take an antibiotic. That will help you and your doctor determine the dosage. Owen says that some medications used to treat viruses can cause kidney injury. It’s important, he says, to stay hydrated when taking medications like acyclovir or valacyclovir. When dehydrated, the medication can clump together and create crystals that prevent you from urinating properly, he says.
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