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GoodRx Health10 Medications That May Raise Your Risk of Kidney Damage

Understanding Nephrotoxic Medications and Their Impact on Kidney Health

Medications that pose a risk to kidney health, known as nephrotoxic medications, are prevalent in both outpatient and hospital settings. Understanding which drugs are harmful and how they affect renal function is crucial for managing patient care, particularly for those with preexisting kidney conditions or those on complex medication regimens. This article outlines the top 10 nephrotoxic medications, highlighting their impact on the kidneys and offering practical guidance for clinical practice.

Key Points:

  1. NSAIDs:
    • Commonly used for pain and inflammation.
    • Examples: Ibuprofen (Advil), Naproxen (Aleve), Meloxicam (Mobic).
    • Can reduce blood flow through the kidneys, increasing the risk of kidney damage, especially in patients with heart failure, liver disease, or existing kidney problems.
    • Recommended to be used sparingly and at the lowest effective dose.
  2. Diuretics:
    • Used to treat conditions like high blood pressure and heart failure.
    • Examples: Hydrochlorothiazide, Furosemide (Lasix), Spironolactone (Aldactone).
    • Can cause acute kidney injury by lowering blood volume and disrupting filtration.
    • Higher doses pose a greater risk for kidney damage.
  3. ACE Inhibitors:
    • Used for managing high blood pressure and heart failure.
    • Examples: Lisinopril (Zestril), Enalapril (Vasotec), Ramipril (Altace).
    • Can protect kidneys in certain conditions but also carry a risk of causing kidney injury, especially if the patient is dehydrated or on other nephrotoxic drugs.
  4. Iodinated Radiocontrast:
    • Used in diagnostic imaging tests.
    • Can cause kidney injury within 24 to 48 hours post-exposure, particularly in those with chronic kidney disease or low blood volume.
  5. Vancomycin:
    • Antibiotic used for serious infections like MRSA.
    • Kidney damage usually occurs within 17 days of treatment but often improves after discontinuation.
    • Requires close monitoring during treatment.
  6. Aminoglycoside Antibiotics:
    • Examples: Gentamicin, Tobramycin, Streptomycin.
    • Known for causing kidney injury, especially with prolonged use or in patients with preexisting kidney conditions.
    • Administered in hospital settings for close monitoring.
  7. HIV Medications:
    • Examples: Tenofovir disoproxil fumarate (Truvada), Atazanavir (Reyataz).
    • Can cause acute kidney injury, necessitating lower doses for patients with existing kidney issues.
    • Newer formulations like Tenofovir alafenamide (Vemlidy) have a lower risk.
  8. Other Antiviral Medications:
    • Examples: Acyclovir (Zovirax), Ganciclovir, Foscarnet.
    • Can cause kidney injury through crystal formation in the kidneys, particularly in dehydrated patients.
  9. Zoledronic Acid:
    • Used for treating osteoporosis.
    • Rare but serious risk of kidney damage, particularly in those with preexisting kidney issues.
    • FDA has issued warnings about its risks.
  10. Calcineurin Inhibitors:
    • Examples: Cyclosporine (Neoral), Tacrolimus (Prograf).
    • Immunosuppressants used post-organ transplant.
    • Higher doses increase the risk of kidney damage.

Drug-induced renal failure (DIRF) occurs in 18% to 27% of hospitalized patients with acute renal failure (ARF), and 20% of hospital admissions for ARF are reportedly caused by drugs, particularly nonsteroidal anti-inflammatory drugs (NSAIDs). (US Pharmacist)

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