What medications can cause kidney damage?

Keeping Kidneys Safe: Smart Choices about Medicines

If you have chronic kidney disease (CKD), diabetes, or high blood pressure—or if you take certain blood pressure medicines that affect your kidneys—you should take steps to protect your kidneys from harm.

ACE inhibitors and ARBs are two types of blood pressure medicine that may slow the loss of kidney function and delay kidney failure. You can tell if you’re taking one of these medicines by its generic name. ACE inhibitors end in –pril and ARBs have generic names that end in –sartan; for example, lisinopril and losartan.

You may also take a diuretic, sometimes called a water pill, to meet your blood pressure goals.

The information below explains

• actions you can take to keep your kidneys safe while taking these blood pressure medicines
• why you sometimes need to take special care with medicines; for example, when you’re sick, dehydrated, or thinking about whether or not to take an over-the-counter (OTC) medicine

Manage your medicines with help from your health care providers

At the pharmacy

The next time you pick up a prescription or buy an OTC medicine or supplement, ask your pharmacist how the product may affect your kidneys or react with other medicines you take.

Fill your prescriptions at only one pharmacy or pharmacy chain so your pharmacist can monitor your medicines and supplements, and check for harmful interactions between your medicines.

At your doctor’s office

Keep an up-to-date list of your medicines and supplements in your wallet. Take your list with you, or bring all your medicine bottles, to all health care visits.

Be careful about using over-the-counter medicines

If you take OTC or prescription medicines for headaches, pain, fever, or colds, you may be taking a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs include popular pain relievers and cold medicines that can damage your kidneys if you take them for a long time, or lead to acute kidney injury if you take them when you are dehydrated or your blood pressure is low.

Ibuprofen and naproxen are NSAIDs. NSAIDs are sold under many different brand names, so ask your pharmacist or health care provider if the medicines you take are safe to use.

You also can look for NSAIDs on Drug Facts labels like the one below.

Plan ahead to manage pain, flu, or other illness

Almost everyone gets sick once in a while. Your doctor or pharmacist can help you plan ahead to keep your kidneys safe until you get well. Prepare in advance so you know what to do if you have pain or a fever, diarrhea, nausea, or vomiting, which can lead to dehydration.

Before you get sick, ask your health care provider or pharmacist the following questions

• If I get sick, are there medicines I should not take while I’m sick?
• If I need to stop medicines when I’m sick, when can I restart them?
• What can I take or do to relieve a headache or other pain?
• What can I take to relieve a fever?
• If I have diarrhea or am vomiting, do I need to change how or when I take my blood pressure medicine?

Watch a video explaining why it’s important to plan ahead for illness and how NSAIDs can harm your kidneys

Discuss this video with your doctor, nurse, or pharmacist before you make any changes to the way you take your medicines.

If blood pressure medicines help my kidneys, why all this extra caution?

In normal, everyday circumstances, taking your blood pressure medicines as prescribed helps protect your kidneys. However, certain situations, such as when you’re dehydrated from the flu or diarrhea, can lower the blood flow to your kidneys and cause harm.

Factors that can add up to cause harm

When you get sick from something like the flu or diarrhea, or have trouble drinking enough fluids, the blood pressure in your body may decrease. As a result, the pressure in your kidneys can be low, too.

In most cases, healthy kidneys can protect themselves. However, if you keep taking your blood pressure medicines when you’re dehydrated or have low blood pressure, your kidneys might have a hard time protecting themselves. The pressure within your kidneys might drop so low that your kidneys won’t filter normally.

If you’re dehydrated, NSAIDs can also keep your kidneys from protecting themselves. As a result, taking NSAIDs when you’re sick and dehydrated can cause kidney injury.

Other ways to protect your kidneys

Read about what else you can do to keep your kidneys healthy. If you already have CKD, the steps you take to protect your kidneys also may help prevent heart disease—and improve your health overall.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Last Reviewed June 2018
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank Jeffrey Fink, MD, MS, Chief, Division of General Internal Medicine, University of Maryland School of Medicine

Treatment — Chronic kidney disease

The following lifestyle measures are usually recommended for people with kidney disease:

• stop smoking if you smoke
• eat a healthy, balanced diet
• restrict your salt intake to less than 6g a day – that’s around 1 teaspoon
• do regular exercise – aim to do at least 150 minutes a week
• manage your alcohol intake so you drink no more than the recommended limit of 14 units of alcohol a week
• lose weight if you’re overweight or obese
• avoid over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, except when advised to by a medical professional – these medicines can harm your kidneys if you have kidney disease

Find out more about living with CKD and what you can do to stay healthy.

Medicine

There’s no medicine specifically for CKD, but medicine can help control many of the problems that cause the condition and the complications that can happen as a result of it.

You may need to take medicine to treat or prevent the different problems caused by CKD.

High blood pressure

Good control of blood pressure is vital to protect the kidneys.

People with kidney disease should usually aim to get their blood pressure down to below 140/90mmHg, but you should aim to get it down to below 130/80mmHg if you also have diabetes.

There are many types of blood pressure medicines, but medicines called angiotensin converting enzyme (ACE) inhibitors are often used. Examples include ramipril, enalapril and lisinopril.

Side effects of ACE inhibitors can include:

• a persistent dry cough
• dizziness
• tiredness or weakness
• headaches

If the side effects of ACE inhibitors are particularly troublesome, you can be given a medicine called an angiotensin-II receptor blocker (ARB) instead.

Diabetes or high ACR

If you also have type 2 diabetes or a high albumin to creatinine ratio (ACR) you may be offered a medicine called dapagliflozin, as well as medicines for high blood pressure. Dapagliflozin helps to lower your blood sugar and can reduce damage to your kidneys.

High cholesterol

People with CKD have a higher risk of cardiovascular disease, including heart attack and stroke.

This is because some of the causes of kidney disease are the same as those for cardiovascular disease, including high blood pressure and high cholesterol.

You may be prescribed medicines called statins to reduce your risk of developing cardiovascular disease. Examples include atorvastatin and simvastatin.

• headaches
• feeling sick
• constipation or diarrhoea
• muscle and joint pain

High potassium levels

People with CKD can develop high potassium levels in their blood, called hyperkalaemia, because their kidneys do not work properly.

Hyperkalaemia can cause muscle weakness, stiffness and tiredness. If it becomes severe, it can cause an irregular heartbeat (arrhythmia) which can lead to a heart attack.

If you have CKD, it’s important to avoid taking potassium supplements and some medicines used to treat high blood pressure and heart failure because they can make your potassium levels too high. Talk to a GP about the medicines you take if you’re worried.

A medicine called sodium zirconium cyclosilicate can be used to treat hyperkalaemia in adults, but only if it’s used:

• in emergency care for acute life-threatening hyperkalaemia alongside standard care
• in people with hyperkalaemia that does not get better, CKD stage 3b to 5, or heart failure

People with hyperkalaemia that does not get better (called persistent CKD) who also have CKD stage 3b to 5, or heart failure, should only take sodium zirconium cyclosilicate if they:

• have a serum potassium level of at least 6.0 mmol/litre and
• are not also taking a certain amount of renin-angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia and
• are not on dialysis

You should stop taking sodium zirconium cyclosilicate if RAAS inhibitors are no longer suitable for you.

Water retention

You may get swelling in your ankles, feet and hands if you have kidney disease.

This is because your kidneys are not as effective at removing fluid from your blood, causing it to build up in body tissues (oedema).

You may be advised to reduce your daily salt and fluid intake, including fluids in food such as soups and yoghurts, to help reduce the swelling.

In some cases you may also be given diuretics (tablets to help you pee more), such as furosemide.

Side effects of diuretics can include dehydration and reduced levels of sodium and potassium in the blood.

Anaemia

Many people with advanced-stage CKD develop anaemia, which is a lack of red blood cells.

Symptoms of anaemia include:

• tiredness
• lack of energy
• shortness of breath
• a pounding, fluttering or irregular heartbeat (palpitations)

If you have anaemia, you may be given injections of a medicine called erythropoietin. This is a hormone that helps your body produce more red blood cells.

If you have an iron deficiency as well, iron supplements may also be recommended.

If you have anaemia but do not have iron deficiency, you may be given a medicine called Roxadustat. This medicine helps your body to produce more red blood cells and comes as tablets.

Want to know more?

• National Institute for Health and Care Excellence (NICE): treating anaemia in people with chronic kidney disease

Bone problems

If your kidneys are severely damaged, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it.

Along with calcium, phosphate is important for maintaining healthy bones. But if your phosphate level rises too much, it can upset the balance of calcium in your body and lead to thinning of the bones.

You may be advised to limit the amount food you eat which are high in phosphate, such as red meat, dairy products, eggs and fish.

If this does not lower your phosphate level enough, you may be given medicines called phosphate binders. Commonly used medicines include calcium acetate and calcium carbonate.

Some people with CKD also have low levels of vitamin D, which is necessary for healthy bones.

If you’re low in vitamin D, you may be given a supplement called colecalciferol or ergocalciferol to boost your vitamin D level.

Glomerulonephritis

Kidney disease can be caused by inflammation of the filters inside the kidneys, known as glomerulonephritis.

In some cases this happens as a result of the immune system mistakenly attacking the kidneys.

If a kidney biopsy finds this is the cause of your kidney problems, you may be prescribed medicine to reduce the activity of your immune system, such as a steroid or a medicine called cyclophosphamide.

Want to know more?

• Kidney Care UK: medicines for chronic kidney disease

Improving muscle strength

If you are having a bad flare-up and are unable to exercise, you may be offered electrical stimulation to make your muscles stronger.

This is where electrodes are placed on your skin and small electrical impulses are sent to weak muscles, usually in your arms or legs.

Dialysis

For a small proportion of people with CKD, the kidneys will eventually stop working.

This usually happens gradually, so there should be time to plan the next stage of your treatment.

One of the options when CKD reaches this stage is dialysis. This is a method of removing waste products and excess fluid from the blood.

There are 2 main types of dialysis:

• haemodialysis – this involves diverting blood into an external machine, where it’s filtered before being returned to the body
• peritoneal dialysis – this involves pumping dialysis fluid into a space inside your tummy to draw out waste products from the blood as they pass through vessels lining the inside of your tummy

Haemodialysis is usually done about 3 times a week, either at hospital or at home. Peritoneal dialysis is normally done at home several times a day, or overnight.

If you don’t have a kidney transplant, treatment with dialysis will usually need to be lifelong.

Talk to your doctor about the pros and cons of each type of dialysis and which type you would prefer if your kidney function becomes severely reduced.

Want to know more?

• Find out more about dialysis
• Kidney Patient Guide: treating kidney failure with dialysis
• Kidney Care UK: dialysis

Kidney transplant

An alternative to dialysis for people with severely reduced kidney function is a kidney transplant.

This is often the most effective treatment for advanced kidney disease, but it involves major surgery and taking medicines (immunosuppressants) for the rest of your life to stop your body attacking the donor organ.

You can live with one kidney, which means donor kidneys can come from living or recently deceased donors.

But there’s still a shortage of donors, and you could wait months or years for a transplant.

You may need to have dialysis while you wait for a transplant.

Survival rates for kidney transplants are very good. About 90% of transplants still function after 5 years and many work usefully after 10 years or more.

Want to know more?

• Find out more about kidney transplants
• Kidney Patient Guide: transplants
• Kidney Care UK: kidney transplant

Supportive treatment

You’ll be offered supportive treatment if you decide not to have dialysis or a transplant for kidney failure, or they’re not suitable for you. This is also called palliative or conservative care.

The aim is to treat and control the symptoms of kidney failure. It includes medical, psychological and practical care for both the person with kidney failure and their family, including discussion about how you feel and planning for the end of life.

Many people choose supportive treatment because they:

• are unlikely to benefit from or have a good quality of life with treatment
• do not want to go through the inconvenience of treatment with dialysis
• are advised against dialysis because they have other serious illnesses, and the negative aspects of treatment outweigh any likely benefits
• have been on dialysis, but have decided to stop this treatment
• are being treated with dialysis, but have another serious illness, such as severe heart disease or stroke, that will shorten their life

Supportive care through the kidney unit can still help you to live for some time with a good quality of life.

Doctors and nurses will make sure you receive:

• medicines to protect your remaining kidney function for as long as possible
• medicines to treat other symptoms of kidney failure, such as feeling out of breath, anaemia, loss of appetite or itchy skin
• help to plan your home and money affairs
• bereavement support for your family

Want to know more?

• Cruse Bereavement Care
• Kidney Patient Guide: the emotional effects of kidney failure
• Kidney Research UK: information on choosing not to start dialysis
• Kidney Care UK: deciding not to have dialysis (conservative treatment)

Page last reviewed: 22 March 2023
Next review due: 22 March 2026

Can Medication Damage Your Kidneys?

Over-the-counter pain medication, laxatives, or antibiotics; no matter the medication, it all passes through your kidneys. And as your kidney’s primary function is to remove waste products from your body, it’s important to be smart when it comes to what you put into your body — this includes your medication.

According to The National Kidney Foundation, thousands of the U.S. population have damaged their kidneys by taking medication in the wrong way or for a prolonged period of time. This is why following medical advice and only taking medication when necessary is crucial. Some of the medications that can potentially cause damage to the kidneys include:

• Laxatives
• Anti-Inflammatory Drugs (NSAIDs)
• Antibiotics

Buy an At-Home Kidney Function Test

Check in on your kidney health from the comfort of home with our at-home test.

What medications can damage your kidneys?

No matter what medication you take — it’s bound to make its way through your kidneys. If you’re taking it in excessive amounts or in the wrong way, it can lead to serious complications for your kidneys [1]. Though you can survive with one kidney — it’s important to keep both in good shape! Here’s what to know about just some of the medications that can cause kidney damage.

Laxatives

The FDA has reported that there is a selection of laxatives connected to a sudden loss of kidney function and blood mineral disturbances — this particularly concerns those already living with kidney disease though it can also affect others [2]. They have also warned that taking more than the recommended amount can cause rare but serious harm to the kidneys and heart. If you need to take laxatives, make sure to discuss the options with your doctor.

Anti-Inflammatory Drugs (NSAIDs)

Anti-inflammatory drugs are medicines that are commonly used to relieve pain, reduce inflammation or help with a fever. Well-known over-the-counter medications such as aspirin, naproxen, and ibuprofen are all common examples. If these are taken in high quantities, they can reduce the blood flow to the kidneys [3]. When it comes to pain medication, it’s important to talk to your doctor before you begin taking them regularly.

Antibiotics

Like all medications on this list, if antibiotics aren’t taken with care and in the correct way, they can cause serious harm to your kidneys. While some antibiotics contain substances that can damage certain kidney cells and/or disrupt your urine flow, others might cause a reaction that can cause kidney damage; this is more common in those who are on a high dosage or are taking antibiotics for a long period of time [4]. Remember to only take antibiotics prescribed to you by your doctor.

What would indicate damage to the kidneys?

It’s estimated that over 37 million adults in the U.S. are living with kidney disease, and the majority don’t even realize it. The reason for this being simple; those living with kidney disease often don’t experience any symptoms until the very late stages and other earlier signs can often go unnoticed.

Although the most reliable way to know more about your kidney health is with a kidney function test, there are some signs to keep an eye out for, these include:

• Weight loss
• Poor appetite
• Fatigue
• Difficulty sleeping
• Frequent urge to urinate
• Cramping muscles

If you are at an increased risk of kidney disease as a result of conditions such as high blood pressure or diabetes, you smoke or you have a family history of kidney disease; it’s important to keep a close eye on your kidney health and regularly get tested.

How can I check my kidney function?

With LetsGetChecked’s kidney function test it’s possible to check your kidney health from the comfort of your own home. Although if you’re concerned about your kidney health and feel you need immediate attention — visit your doctor as soon as possible.

The LetsGetChecked kidney function test will allow you to monitor your kidney function and performance and you’ll receive your online results within a week. This test will indicate how your kidneys are performing by measuring levels of urea, creatinine, and eGFR. High levels of urea, creatinine and a low eGFR can indicate acute or chronic kidney disease.

You should consider taking a test if:

• You suffer from high blood pressure
• You suffer from diabetes
• You have suffered an acute injury
• You have persistent urinary tract infections
• You have a kidney disease or a family history of one
• You have kidney stones or a family history of them
• You have a high protein diet
• You have been taking performance enhancing drugs

Buy an At-Home Kidney Function Test

Check in on your kidney health from the comfort of home with our at-home test.

References

1. National Kidney Function. Which drugs are harmful to your kidneys? Online: Kidney.org
2. U.S Food & Drug Administration. Use certain laxatives with caution. Online: Fda.gov, 2014
3. National Kidney Function. Which drugs are harmful to your kidneys? Online: Kidney.org
4. National Kidney Function. Which drugs are harmful to your kidneys? Online: Kidney.org