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Conditions & Treatments


6 TYPES OF MEDICATIONS THAT CAN HARM YOUR KIDNEYS


DOZENS OF COMMON DRUGS CAN CAUSE DAMAGE IF YOU’RE NOT CAREFUL

--------------------------------------------------------------------------------

By

Barbara Sadick,

 

AARP
En español
May 23, 2023
Shana Novak / Getty Images
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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, associate 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.

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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,” he 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
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 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.




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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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Some people, Owen says, may have allergic reactions to antibiotics in their
kidneys. The reaction is sometimes just in the kidneys and at other times can
cause a rash or a fever. Such a reaction in the kidneys is caused by
inflammation and irritation. Owen stresses the importance of letting your health
care team know if you have any changes in how much you urinate after any course
of antibiotics.



If not taken as directed or in doses that are too high, antibiotics can be
dangerous and more likely to cause problems. People with decreased kidney
function should be taking smaller doses than others. 




3.   LAXATIVES



What they are: Laxatives are usually taken to alleviate constipation and to
clean the bowel before a colonoscopy. Medications used to prepare for a
colonoscopy require a prescription and are usually taken orally by tablets,
capsules, powders, liquids or as suppositories.



Examples: Some of the most common OTC laxatives include bisacodyl (Dulcolax),
senna (Senokot, Ex-Lax), docusate (Colace) and polyethylene glycol (Miralax).



How they can affect the kidneys: If taken as directed, most laxatives are safe
for those without kidney problems. For those with kidney disease, it’s important
to keep well hydrated by drinking lots of water and clear liquids. Dehydration
can cause damage to the kidneys by decreasing blood flow to them.



Sometimes, overusing laxatives can cause kidney stones.  If you need to take
laxatives multiple times a week to treat constipation, says Owen, check with
your health care team to make sure it’s safe for you.



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4.   CONTRAST DYES




What they are: Contrast dyes are either swallowed or injected for use in
diagnostic tests such as CT scans, MRIs and angiograms to enhance images used
for diagnosis and treatment.




Examples:  CT scans use iodine-based contrasts and MRIs use gadolinium-based
contrasts.



How they can affect the kidneys:  While rare, contrast dyes used for scans can
lead to serious kidney problems. Owen says that iodine contrast dye for CT scans
can lead to contrast-induced nephropathy.  That means that the contrast dye can
temporarily change how well the blood flows to and from the kidneys.  Gadolinium
contrast dye used for MRIs, says Owen, can cause nephrogenic systemic fibrosis
or a thickening or darkening of some spots on the skin.  He says this can happen
when someone who already has kidney disease gets an MRI and advises that before
getting an MRI or CT scan, your health care team should check your kidney
function to make sure it’s safe.




5.  ACID SUPPRESSANTS



What they are: Acid suppressants are used to prevent and treat heartburn and
indigestion by reducing acid in the stomach and can be purchased both OTC and by
prescription.



Examples: Some of the most common acid suppressants include omeprazole
(Prilosec) and esomeprazole (Nexium), famotidine (Pepcid) and calcium carbonate
(Tums).



How they can affect the kidneys:  Owen says that some acid suppressants can
cause kidney inflammation and irritation.  Medications like omeprazole or
esomeprazole should be taken only for short durations (less than a month), he
says.  If you’re taking an acid suppressant for more than a month, speak with
your health care team. If taking calcium carbonate (Tums) regularly to treat
heartburn or indigestion, talk with your health care team to see if there are
other options.




6.  HERBAL SUPPLEMENTS



What they are:  Herbals can be a type of dietary supplement with therapeutic
properties that are sold as tablets, capsules, powders, tea, extracts and as
fresh or dried plants. Although many people use them because they believe they
improve health, they don’t go through the kind of testing that’s required of
drugs and can be potentially dangerous.



Examples:  A 2007 review of supplement-induced kidney dysfunction lists more
than 15 herbs and supplements reported to have caused kidney problems,
including chromium, creatine, licorice, willow bark, vitamin C and yohimbe. (See
box for a list of supplements that should be avoided if you have kidney
disease.)



How they can affect the kidneys:  Don’t assume that because they’re “natural”
herbal supplements are always safe. Some can interact badly with prescription
medication. Others can act as a diuretic or a water pill and can cause kidney
irritation or damage. Multiple herbal supplements contain potassium and
phosphorous, both of which may need to be limited in people with kidney disease,
Owen says. Generally, people with kidney disease should not use herbal
supplements without first speaking with a doctor or a pharmacist.


HERBAL SUPPLEMENTS TO AVOID IF YOU HAVE KIDNEY DISEASE

 * Astragalus
   
 * Apium graveolens
 * Horsetail
 * Licorice root
 * Parsley root
 * Uva ursi
 * Barberry
 * Creatine
 * Huperzinea
 * Nettle (and stinging nettle)
 * Pennyroyal
 * Yohimbe
 * Cat’s claw
 * Goldenrod
 * Java tea leaf
 * Oregon grape root
 * Ruta graveolens

Source: National Kidney Foundation

%{postComment}%

Based in New York, Barbara Sadick is a freelance health journalist. Her work has
appeared in The Wall Street Journal, U.S. News & World Report and The Washington
Post, among other publications.


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How to protect this vital organ and recognize the signs of disease


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