This warning: medications to be aware of if you have kidney disease is important because this awareness can be life-saving, especially if you have advanced chronic kidney disease (CKD). Read this article carefully. Medications (also called drugs) vary and may be classified as those that require a doctor’s prescription: known as “prescription drugs” and those that do not require a prescription, referred to as “over-the-counter medications.” Regardless of the type or source of the medication, medications must be processed by your body either through your kidneys, your liver or both. It is prudent to know the warning: medications to be aware of if you have kidney disease. There are many drugs that can harm your kidneys.
Talk to your doctor, and if you have Advanced Chronic Kidney Disease please also talk to your Nephrologist (or kidney specialist)! Advanced chronic kidney disease (CKD) is defined as CKD stages 4 and 5.
The glomerular filtration rate (GFR) is a measure of kidney function that has many uses including the staging of chronic kidney disease (CKD). Another role of the GFR is to help determine the risks and dosing requirements of many medications. Therefore, in levels for advanced kidney disease where the levels of GFR are reduced, special attention is needed to medications. To learn more about the GFR, please visit our page dedicate to explaining your kidney-related blood tests! The GFR is levels in advanced CKD are as follows:
- CKD Stage 4: GFR: 15-29
- CKD Stage 5: GFR less than 15
Advanced kidney disease amplifies the warning: medications to be aware of if you have kidney disease.
Warning: Medications to be Aware of if You Have Kidney disease
Over-The Counter Medications that Can Harm Your Kidneys
Over-the-counter medications are a very important part of the warning: medications to be aware of if you have kidney disease. Over-the-counter medications medications that are readily available without a prescription: You can simply walk into any pharmacy and purchase them of your own accord. The fact that you can purchase these medications without a prescription does not mean that they are harmless. For example, Tylenol is considered as a mild and save over-the-counter medication, however, in large quantities it can cause liver failure. therefore, it is important to know that over-the-counter medications can sometimes be harmful.
They can certainly damage your kidneys, liver and can also affect your blood pressure and other body functions.
It is therefore very important for you to tell your doctor about all the medications you are taking including the ones that you have purchased over-the-counter in a pharmacy, at Walmart, Walgreens, Rite Aid, online on Amazon or anywhere else.
It is also important for you to let your doctor know if you are taking any medications that were prescribed in another country because there are some medications that are not distributed in the United States but can be obtained in other countries. The country of origin does not change the fact that some medications may be harmful or that blood tests may need to be monitored for kidney function, doses might need to be adjusted or other advice given as necessary, based on your kidney function or liver function.
Over-the-counter medications that can harm your kidneys include:
- Sinus medications
- Heartburn medications known as PPIs
- Vitamin C in high doses
- Phosphorus-containing laxatives
- Herbal Supplements/Substances
- Other- Miscellaneous medications that can indirectly cause harm to you or your kidneys in the setting of kidney disease
NSAIDS: Non-steroidal anti-inflammatory drugs are otherwise known as NSAIDs. They can cause acute kidney injury amongst other ill effects on the kidneys. NSAIDs can cause acute interstitial nephritis (AIN) which is a unique form of kidney inflammation and NSAIDs can also cause nephrotic syndrome via minimal change disease. The NSAIDs are perhaps one of the most harmful subgroups of the warning: medications to be aware of if you have kidney disease.
The AIN caused by NSAIDs is not usually as obvious as AIN caused by other drugs. When AIN is caused by other drugs, it tends to be heralded or accompanied by a rash, fever and elevated eosinophils: a condition called eosinophilia seen on blood test results. However when NSAIDs cause AIN these telltale signs may be absent and so it may be missed as you may not go to the doctor as you may not be alarmed that there is something wrong. NSAIDs can also increase your blood pressure, increase your risk of heart attack and increase your risk of stroke.
You should therefore talk to your doctor & limit your use of NSAIDs to only IF absolutely necessary, even if you do not have kidney disease. This is therefore an important part of the warning: medications to be aware of if you have kidney disease.
Warning: Medications to be Aware of if You Have Kidney disease- Read Your Medication Labels Carefully to Avoid Taking Double Doses of The Same NSAID
These popular over-the-counter-names for NSAIDs are brand names like Motrin, Advil, Aleve, Naprosyn and their generic brand equivalents that may be labelled as Equate, Walgreens, CVS, RiteAid etc.
The Generic medication names to check the labels for are ibuprofen and naproxen. NSAIDs are perhaps one of the most harmful subgroups of the warning: medications to be aware of if you have kidney disease because people may use multiple doses of the same NSAID due to differences in trade names resulting in them taking higher doses than intended. It is therefore very important to read the active ingredients on the label.
For those who receive prescribed NSAIDs they may receive ibuprofen and naproxen at doses higher than those available over the counter or otherwise will receive NSAIDs that strictly require a prescription such as diclofenac (cataflam or voltaren), celecoxib, meloxicam, etodolac, ketoprofen, fenoprofen, indomethacin, ketorolac, nabumetone and oxaprozin.
Sinus Medicines: Decongestants. Sinus congestion, allergy, and some cough medicines contain decongestants which are medications used to clear the nostrils. These medications may be seen listed as phenylephrine, pseudoephedrine and other ingredients in your over-the-counter medicines. They are known as sympathomimetics and can elevate the blood pressure and harm the kidneys. Pseudoephedrine can also cause kidney stones: another way in which it can harm your kidneys.
Heartburn medications known as PPIs
Acid reflux medicines otherwise known as heartburn medicines called proton pump inhibitors (PPIs). Popular examples are Nexium OTC and Prilosec-OTC: there are also generic brands available like CVS, Walgreens, Equate, Rite Aid brands and other alternatives. Prescription strength doses are also available by doctors. There are therefore other related names that you may see like pantoprazole, omeprazole, lansoprazole, esomeprazole. This category of medicines, PPIs can damage your kidneys by a condition called interstitial nephritis.
However the PPIs can do even more harm to other aspects of your body as they can reduce magnesium levels, increase risk increase risk of osteoporosis, increase the risk of an infectious diarrhea due to Clostridium. difficile, and has been shown to risk of death (all-cause mortality).
Vitamin C in high doses
Vitamin C: Vitamin C in large doses can cause kidney damage. There are 2 ways that high dose vitamin C can damage your kidneys:
- A condition called oxalate nephropathy
- Causing kidney stones
It is therefore best to get your supply of vitamin C from a healthy balanced diet. however, if you find yourself needing supplements, it is best to avoid amounts of greater than 500 milligrams per day.
Phosphorus containing laxatives: oral and even enemas can cause absorption of high amounts of phosphate. This can cause a phosphate nephropathy which can further harm the kidneys in addition to other harmful effects.
Herbal supplements: They are not regulated nor approved by the FDA and may contain substances that can damage the kidneys and/or the liver
Other Over-the-Counter Medications to Watch Out For if You Have Kidney Issues
These are miscellaneous medications that can indirectly cause harm to you or your kidneys in the setting of kidney disease.
- If you have an enlarged prostate that causes blockage off the flow of your urine and therefore obstruction called an obstructive uropathy and consequent obstructive nephropathy (kidney trouble): then you should be very careful to avoid antihistamines otherwise known as over-the-counter allergy medicines, for example Benadryl and the other generic brands related to it, because these can precipitate obstruction of your urine flow.
- If you have advanced chronic kidney disease (CKD Stage 4 or CKD Stage 5), you should avoid aluminum containing antacids like as they can result in aluminum toxicity and severe consequences. Examples of Aluminum-containing antacids are Mylanta (which contains 800mg of Aluminum hydroxide per dose), Gaviscon (254mg per 5ml) and the other equivalents marketed as generic brands in your neighborhood stores like Walmart, Walgreens, CVS , Rite Aid etc. The manifestations of aluminum toxicity include encephalopathy, osteodystrophy, and anemia. The symptoms may range from bone pain, muscle aches, tiredness, confusion and altered mental state to seizures. If you have advanced chronic kidney disease, this warning: medications to be aware of if you have kidney disease is particularly serious when choosing these seemingly harmless heartburn medicines. They are harmful if you have advanced CKD.
- Be careful when taking antacids that contain Magnesium like Phillips Milk of Magnesia, Gaviscon etc: the risk of magnesium toxicity increases in advanced chronic kidney disease.
Prescription Medications That Need Special Attention if You Have Kidney Disease
There are some prescription medications (in addition to the above over the counter medications) that your health care provider will need to address, monitor decrease, or discontinue if you have kidney disease and even more so if you develop advanced Chronic Kidney Disease.
In the presence of advanced chronic kidney disease (CKD), these are some of the medications that: capable of causing:
- Can cause harmful adverse effects to your body
- Can Further damage to the kidneys
- Need dose adjustments
- Need to be stopped or
- Require close monitoring
The list below touches on some medications, but it is not a complete list of all the medications that need attention. Please talk to your doctor for that provider to decide which medications need to be stopped, lower dose or monitoring as the decision has to be made by your doctor who has your full history of your unique condition, and lab test results! Your doctor will also be able to explain any exceptions to the rules allowed by your unique case and the balancing of risk versus benefits of medications. The medications include:
- Some Chemotherapy agents
- Many Antibiotics
- Many Antivirals
- Many Sedatives
This topic “warning: medications to be aware of if you have kidney disease” is very, very, important and the information can be life-saving. Please review the over-the-counter medications you have at home and talk to your doctor.