Many people are surprised to learn that some common medicines can affect the kidneys. But that doesn’t mean these medicines are unsafe or should be avoided by everyone.
Your kidneys help remove medicines and their byproducts from the body. Some medications can reduce blood flow to the kidneys, cause kidney injury in certain circumstances, or accumulate when kidney function is already reduced. The risk depends on the drug, dose, duration, kidney function, hydration and other medicines being taken. NIDDK
So why are these medicines still sold?
Because many of them provide important benefits when used correctly. The goal is not to stop necessary medication, but to use it appropriately and understand when extra caution is needed.
1. Ibuprofen and Other NSAIDs
Common nonsteroidal anti-inflammatory drugs (NSAIDs) include:
Ibuprofen
Naproxen
Diclofenac
Indomethacin
Celecoxib
These medicines are widely used for pain, inflammation and fever.
The problem is that NSAIDs can reduce blood flow to the kidneys. Regular or high-dose use can increase the risk of kidney damage, particularly in people with chronic kidney disease, heart disease, high blood pressure or dehydration. NIDDK
Important: Taking an NSAID occasionally is very different from taking high doses regularly.
2. Certain Antibiotics
Some antibiotics are eliminated through the kidneys, while others can themselves cause kidney injury in susceptible people.
People with reduced kidney function may need a different dose or dosing schedule. The National Kidney Foundation notes that many antibiotics can still be used safely in people with kidney disease when appropriately selected and dosed. National Kidney Foundation
Never stop an antibiotic simply because you are concerned about your kidneys. Ask your doctor or pharmacist whether the particular antibiotic and dose are appropriate.
3. Some Antiviral Medicines
Certain antiviral medications are also cleared through the kidneys.
When kidney function is reduced, the dose may need to be adjusted to prevent excessive levels of the medicine from accumulating in the body. National Kidney Foundation
This is one reason healthcare professionals may check kidney function before or during treatment with particular medicines.
4. Lithium
Lithium is an important prescription medicine used to treat certain psychiatric conditions.
However, long-term lithium treatment can affect kidney function in some people. Because lithium has a narrow therapeutic range and is cleared by the kidneys, patients taking it generally require appropriate monitoring. National Kidney Foundation
This is not a medication that should ever be stopped or adjusted without medical supervision.
5. Diuretics (“Water Pills”)
Examples include:
Furosemide
Torsemide
Bumetanide
Diuretics help the body remove excess salt and water and are commonly used for conditions such as high blood pressure and heart failure.
They can be extremely beneficial, including for people with kidney disease. However, excessive dosing can contribute to dehydration and electrolyte abnormalities, which can put additional stress on the kidneys. National Kidney Foundation
6. ACE Inhibitors
Examples include:
Lisinopril
Ramipril
Enalapril
Here’s an important misconception: ACE inhibitors are not simply “kidney-damaging pills.”
In fact, ACE inhibitors can protect the kidneys and slow the progression of certain types of kidney disease. They can, however, cause changes in kidney function and potassium levels that require monitoring, particularly when someone becomes dehydrated or takes interacting medicines. National Kidney Foundation
So they should be taken exactly as prescribed rather than avoided because of a viral warning.
7. ARBs
ARBs include:
Losartan
Valsartan
Irbesartan
Olmesartan
Like ACE inhibitors, ARBs can protect the kidneys and heart in appropriate patients. They can also affect kidney function and potassium levels, meaning monitoring may be necessary. National Kidney Foundation
A particularly important situation occurs when an ACE inhibitor or ARB is combined with an NSAID and a diuretic, especially when dehydration is present. This combination can substantially increase the risk of acute kidney injury. National Kidney Foundation
8. Some Proton Pump Inhibitors
Proton pump inhibitors (PPIs) are commonly used to reduce stomach acid and treat conditions such as reflux and ulcers.
Examples include:
Omeprazole
Pantoprazole
Lansoprazole
Esomeprazole
PPIs have been associated with certain kidney problems, including acute interstitial nephritis, although this is uncommon. The National Kidney Foundation lists PPIs among medicines that may require consideration in people with kidney disease. National Kidney Foundation
That doesn’t mean someone taking a PPI should suddenly stop it. If you need long-term acid-suppressing treatment, discuss the appropriate dose and duration with your healthcare professional.
Why Are These Medicines Still Sold?
This is the part viral posts often leave out.
A medicine can have potential risks and still have a favorable benefit-risk balance when used correctly.
For example, NSAIDs can cause kidney problems in certain situations, but they can also provide effective relief from pain and inflammation. ACE inhibitors and ARBs can affect kidney function under certain circumstances while also helping protect kidney and cardiovascular health in appropriate patients. NIDDK
The question isn’t simply:
“Does this medicine affect the kidneys?”
A better question is:
“Is this medicine appropriate for me, at this dose, for this length of time, considering my kidney function and other medications?”
Who Needs Extra Caution?
Kidney-related medication risks can be greater if you:
Already have chronic kidney disease
Are dehydrated
Have heart failure
Have high blood pressure
Have diabetes
Are older
Take several medications at the same time
Regularly use NSAIDs
NIDDK specifically recommends discussing over-the-counter medicines with a healthcare professional because NSAIDs can be particularly problematic when someone is dehydrated or has kidney disease. NIDDK
Warning Signs That Deserve Medical Attention
Possible symptoms of significant kidney problems can include:
Noticeably reduced urine output
New swelling in the legs or feet
Unusual fatigue
Nausea
Shortness of breath
Confusion
However, kidney problems can also develop with few or no obvious symptoms, which is why blood and urine tests are often important when kidney function needs to be checked.
Never Stop Prescription Medication on Your Own
This is especially important with blood-pressure medicines, lithium, diuretics and other long-term treatments.
Stopping medication suddenly can create its own risks.
Instead, tell your doctor or pharmacist about every prescription medicine, over-the-counter drug, vitamin and supplement you take. NIDDK recommends keeping an up-to-date medication list and asking whether medicines may affect your kidneys or interact with one another. NIDDK
The Bottom Line
There are medicines that can harm the kidneys under certain circumstances, but viral lists claiming that ordinary medications are simply “bad for your kidneys” can be misleading.
The most important concerns include NSAIDs such as ibuprofen and naproxen, certain antibiotics and antivirals, lithium, diuretics, and some blood-pressure medicines, while drugs such as ACE inhibitors and ARBs can actually provide kidney protection for appropriate patients. National Kidney Foundation
Don’t stop a medication because of a social-media post. Ask your doctor or pharmacist whether your particular medicine, dose and combination are appropriate for your kidney function.
Do you check whether your medicines are safe for your kidneys? Tell us in the comments 👇
