Which Commonly Used Drugs Are Nephrotoxic?
Jan 09, 2023
The kidney is the most important organ in the human body to metabolize and excrete drugs, so it is easily injured by drugs. "Avoiding the abuse of nephrotoxic drugs" is the basic guarantee for a good prognosis of kidney disease. Next, I would like to talk to you about the list of drugs that are commonly used in daily life but have certain nephrotoxicity. Patients with kidney disease must be careful with these drugs. But before talking about it, it must be stated that not all nephrotoxic drugs cannot be used by patients with kidney disease under any circumstances.
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Everyone understands these two points:
1. When encountering drugs with potential nephrotoxicity, patients with kidney disease should not use them in a daze. If necessary, please find a professional doctor to weigh the pros and cons according to your actual situation before using them;
2. When a professional doctor weighs that the benefits of medication can outweigh the disadvantages, and nephrotoxic drugs have to be used, patients with kidney disease should follow the doctor's advice, not to increase the dose or prolong the course of medication, and pay attention to closely monitor changes in renal function.
Some antibiotics
Antibiotics are often referred to as "anti-inflammatory drugs". The use of antibiotics should strictly follow the indications, but people can easily buy various antibiotics in pharmacies, so they are used quite commonly and casually. This not only leads to the rising rate of antibiotic resistance but also causes frequent cases of antibiotic kidney damage.
1. Aminoglycosides, representative drugs: kanamycin, gentamicin, amikacin, tobramycin, streptomycin, and amikacin.
Aminoglycosides have strong nephrotoxicity and are one of the most common drugs that cause kidney damage, and the intensity of nephrotoxicity is positively correlated with the accumulation of the drug, that is to say, the longer the drug accumulation time and the greater the dose, the the less the nephrotoxicity will be. stronger. This type of drug should not be abused for common colds, fever, and diarrhea. It is mainly used for severe infections, pneumonia, sepsis, burns, and severe urinary tract infections.
2. First-generation cephalosporin: cephalosporin is a well-known anti-inflammatory drug. There are one, two, and three generations of commonly used cephalosporins. The more nephrotoxic cephalosporins are the first generation, including cefotaxime, cefazolin, cephalexin, cephradine, and cephalosporins. Amoxicillin, etc.
The hematuria caused by cephradine was once notified by the National Adverse Drug Reaction Monitoring Center. The report indicated that after collecting literature on drug-induced hematuria (1998-2003), it was found that the proportion of hematuria caused by antibiotics reached 46%, of which cephradine accounted for 34%.
3. Other antibiotics such as vancomycin, amphotericin B, and rifampicin are also potentially nephrotoxic, but these drugs are not commonly used for common infections.
NSAIDs
Non-steroidal anti-inflammatory drugs, you may not be familiar with this name, but this type of ingredient is widely used in daily life, many cold medicines, antipyretics, and painkillers contain it, and its abuse is widespread and common Drugs that cause kidney damage.
NSAIDs include acetaminophen, ibuprofen, ketoprofen, diclofenac, naproxen, indomethacin, etoricoxib, celecoxib, nimesulide, aspirin, and others.
Different types of NSAIDs have different nephrotoxicity. A recent study comparing the nephrotoxicity of different drugs published in the famous nephrology journal CJASN showed that etoricoxib may have the highest risk of kidney injury, while ibuprofen is much lower (but it should be pointed out that low risk does not mean any risk).
Some traditional Chinese medicine
Chinese medicine is a treasure of medicine in our country. Although Chinese medicine is taken from nature, natural does not mean that it has no side effects. In recent years, the nephrotoxicity of Chinese medicine has attracted widespread attention. Scientists have also done a lot of research. Aristolochic acid and alkaloids are common nephrotoxic components.
In addition, there are some traditional Chinese medicines, such as tripterygium wilfordii, motherwort, cocklebur, neem bark, trichosanthes, morning glory, golden cherry root, soil Fritillaria, Nepeta nepeta, croton, animal fish gallbladder, hippocampus, centipede, snake venom, mylabris, And mineral traditional Chinese medicines such as arsenic, realgar, red sail, cinnabar, mercury chloride, light powder, alum, red lead, etc. also have certain nephrotoxicity.
Proton pump inhibitors
Proton pump inhibitors, referred to as PPIs, are commonly used drugs in gastroenterology, and their main function is to inhibit gastric acid secretion. Common drugs are: omeprazole, pantoprazole, lansoprazole, rabeprazole, esomeprazole, etc.
Studies have found that proton pump inhibitors can cause acute or chronic kidney injury. The longer the use time, the higher the risk of renal function decline, uremia, and kidney damage.
Sodium Phosphate
Sodium Phosphate Salt is a cathartic and laxative medicine, used in gastroenterology. Acute kidney injury may occur in people who use sodium phosphate salt, and once the injury occurs, it is difficult to reverse, and there is no specific drug to treat it; patients with kidney disease need to be highly vigilant, and polyethylene glycol can be used instead, which can also achieve good results. laxative effect.
Contrast agent
Contrast agents are often used in angiography and enhanced CT, and are a good helper for doctors in diagnosis and treatment. However, iodine contrast agents and gadolinium contrast agents can cause renal damage, and the incidence is higher in people with renal insufficiency. Care should be taken to weigh the pros and cons.
There are also some drugs that are not commonly used, but also have potential nephrotoxicity, such as: antiviral drug acyclovir, antineoplastic drug cisplatin, antidepressant drug lithium, etc.
Patients with kidney disease should communicate with the doctor in time before using these drugs, and don't be afraid of trouble, just ask more. Provide a detailed medical history with the prescribing doctor: for example, whether the kidney disease is progressing, how the kidney function is; whether you have been dehydrated recently (profuse sweating, diarrhea, vomiting, drinking little water, etc.), whether you have a history of allergies (contrast media) or drug allergy); provide recent detailed medication information, whether or not RAS blockers (Pril and sartan), immunosuppressants, etc. have been taken orally.
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