8 Common Medications That May Affect Kidney Health When Taken in Excess
The headline needs an important qualification: medications don’t automatically damage the kidneys simply because they’re commonly used. Risk depends on the particular drug, dose, duration, kidney function, dehydration, and interactions with other medicines. Some medications that can affect kidney function are also extremely important treatments and should not be stopped without medical advice.
1. NSAID pain relievers
Examples include ibuprofen, naproxen, diclofenac and high-dose aspirin. High doses or prolonged use can reduce blood flow to the kidneys and cause acute kidney injury or worsen chronic kidney disease.
2. Diuretics (“water pills”)
Medicines such as furosemide can be very helpful for high blood pressure and heart failure, but excessive dosing can contribute to dehydration and electrolyte abnormalities, potentially stressing the kidneys.
3. ACE inhibitors and ARBs
Examples include lisinopril and losartan. These medicines can actually protect kidney function in many people, but kidney function and potassium need monitoring, particularly during dehydration or when combined with certain other medicines.
4. Proton-pump inhibitors (PPIs)
Examples include omeprazole, pantoprazole and lansoprazole. Long-term use has been associated with kidney-related problems, including acute kidney injury. The risk-benefit balance should be reviewed if they’re being used for months or years.
5. Certain antibiotics
Some antibiotics can directly affect the kidneys, while others are primarily eliminated through the kidneys and may require dose adjustment when kidney function is reduced.
6. Certain antiviral and antifungal medicines
Some of these drugs can accumulate when kidney function is impaired, while particular agents can themselves cause kidney toxicity. Dosing should therefore take kidney function into account.
7. Lithium
Lithium can be an effective treatment for bipolar disorder but can affect kidney function with long-term use. People taking it require appropriate monitoring rather than abruptly stopping the medication.
8. Oral sodium-phosphate bowel preparations
Some products used to empty the bowel before colonoscopy can cause serious kidney injury in susceptible people. They’re particularly concerning in people with kidney disease, older adults, dehydration, or those taking certain blood-pressure medicines or NSAIDs.
⚠️ A particularly risky combination
One important interaction involves an NSAID + ACE inhibitor/ARB + diuretic, especially when you’re dehydrated from vomiting, diarrhea, fever or poor fluid intake. This combination can substantially increase the risk of acute kidney injury.
What you can do
- Don’t exceed the recommended dose of any medication.
- Check OTC cold and pain medicines for duplicate ingredients, especially NSAIDs.
- Tell your doctor/pharmacist about all prescriptions, OTC medicines and supplements.
- If you have kidney disease, make sure medication doses are being reviewed against your eGFR.
- Don’t stop prescribed blood-pressure, heart, psychiatric or other essential medication without professional guidance.
