By Mariana Markell, MD
The kidneys play an important role in keeping your body functioning properly. They remove wastes and extra fluid from your body and control your blood pressure. They even make a form of vitamin D that’s good for your bones.
Every medicine you take passes through your kidneys. But some medicines can harm them. Here is a list of ten drugs you should be careful with.
NSAIDs are non-steroidal anti-inflammatory drugs, for example Ibuprofen, Naproxyn, Diclofenac. They are used for pain relief, arthritis, headache.
NSAIDs can cause kidney damage in two ways. If you have kidney disease, they can make your kidney function worse especially if you are also taking a diuretic (water pill). They can also cause an allergic reaction called allergic interstitial nephritis (AIN), which is an inflammation of the kidneys. There is also some evidence that taking them for a long time increases your chances for kidney damage.
2. COX2 inhibitors
COX2 inhibitors, such as Celecoxib, are used for pain or arthritis. They work in a similar way to the NSAIDs and have the same effects on the kidneys but are not a known cause of AIN.
3. Certain antibiotics
These antibiotics, for example Gentamycin or Vancomycin, are used for a severe infection and often they must be used. They can damage the kidney tubules especially if the level is high or the drug is used for a long period of time. The chance of having kidney damage is highest if you already have kidney disease or have low blood pressure from a very bad infection. Methicillin is another antibiotic that can also cause the allergic interstitial nephritis (AIN) that is seen with NSAIDs. It is a type of penicillin that is not used very commonly anymore.
4. Proton pump inhibitors
Proton pump inhibitors
include omeprazole, esomeprazole, pantoprazole, and others. People take these medicines for ulcer disease and gastroesophageal reflux disease (GERD). They are probably safe if taken for less than a month or two, but studies suggest that people who take them for a long time increase their chance of getting kidney disease. It is a good idea to ask your doctor if it is safe to change to a drug like ranitidine or famotidine (histamine blockers) if you have been taking a proton pump inhibitor for a long time.
Also commonly called Tylenor, this drug does not damage your kidneys immediately, as can happen with NSAIDs, but if you take acetaminophen for many years your risk of kidney disease may increase. You should speak with your doctor if you are taking acetaminophen every day and have been doing this for a long time. For short-term use, acetaminophen is safe for people with kidney disease, but not for people with liver disease. Also, taking very high doses of acetaminophen (more than 4 grams per day) can cause acute injury to the liver and kidneys.
Duretics, such as furosemide, hydrochlorthiazide, chlorthalidone, or metalozone, are also known as “water pills.” These drugs are used to treat high blood pressure, heart failure, nephrotic syndrome and any problem that causes swelling in the body. They do not damage the kidneys directly unless you get very dehydrated (not enough fluid in the body for normal body function). But they can make other drugs that damage the kidneys more toxic, including NSAIDs, ACEI and ARBs (see below) and the dyes used in CT scans and heart catheterization studies.
7. ACE Inhibitors/ARBs
ACE Inhibotors, such as Lisinopril, Irbisartan or Losartan, are used to protect the kidneys from damage when a person has diabetes, and to treat heart failure. They are also used to treat high blood pressure. Both types of drugs actually protect the kidneys unless a person gets very dehydrated (see diuretics above), has low blood pressure from an infection (or other cause), or has a narrowing of the artery to the kidney. In those situations, they can actually cause kidney function to get worse, although often this situation can be reversed, and the kidney is not actually damaged.
8. Radiocontrast agents
These drugs are also called “dye” and are given for a CT scan or cardiac angiogram (also known as a “cath”). They may also be used to study other blood vessels in the body. The chance of having kidney damage from exposure to these drugs is highest if you are dehydrated (see “diuretics”), are older than 60 years of age, have some kidney disease already or have certain blood diseases like multiple myeloma. Doctors are aware of these risks and try to use the lowest dose possible when you get a study that requires “dye”. It is important to understand that the “dye” used in an MRI study does not damage the kidneys, but it should not be given to someone with chronic kidney disease for other reasons.
9. GLP-1 agonists*
GLP-1 agonists include drugs such as Exenitide and Liraglutide and are used to treat diabetes. In some people, especially those who have kidney disease, there is a chance for having kidney failure if you develop vomiting and dehydration. Exenitide should not be used in people with kidney disease.
10. SGLT2 antagonists*
SGLT2 angagonists, such as empagliflozin, canagliflozin, and dapagliflozin, are used to treat diabetes. People who take these drugs may develop urine infections, and recently, the FDA became concerned that they may cause acute kidney injury. Other studies suggest that they actually protect the kidneys so whether these drugs truly increase chance for kidney injury is not known.
*It is important to remember that controlling your blood sugar
may prevent diabetes-related kidney disease from getting worse. If you are taking one of these drugs and are concerned about your kidney function, you should not stop it without discussing your concerns with your doctor. High blood sugar can definitely damage the kidneys.
The kidneys play an important role in keeping your body functioning properly. They remove wastes and extra fluid from your body and control your blood pressure. They even make a form of vitamin D
that’s good for your bones.