8 Common Medications That May Affect Kidney Health

Your kidneys work continuously to filter waste and extra fluid from your blood. They also help regulate blood pressure, balance minerals, and remove many medicines and their byproducts from the body.

Because of this, some medications can affect kidney function, especially when they are taken at high doses, used for long periods, combined with certain other medicines, or taken by someone who already has reduced kidney function.

This does not mean that these medications are always harmful. In fact, many are important and sometimes essential treatments. The key is using them appropriately and making sure your healthcare professional knows about your kidney function and all the medicines you take.

Here are eight common types of medications that may affect kidney health and what you should know about them.

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are among the most important medications to be aware of when it comes to kidney health.

Common examples include ibuprofen and naproxen. They are widely used to relieve headaches, muscle aches, arthritis pain, menstrual cramps, and other types of inflammation and pain.

NSAIDs can reduce blood flow to the kidneys. In some people, particularly those who already have kidney disease or are dehydrated, this can contribute to acute kidney injury. Long-term or high-dose use may also increase the risk of worsening chronic kidney disease.

The risk can be higher when NSAIDs are combined with certain blood-pressure medications or diuretics.

This does not mean you should automatically avoid every NSAID. Instead, ask a healthcare professional whether one is appropriate for you, particularly if you have kidney disease, high blood pressure, heart failure, or are taking several medications.

When an NSAID is considered appropriate, using the lowest effective dose for the shortest necessary period can help reduce potential risks.

2. Certain Antibiotics

Antibiotics are important medicines used to treat bacterial infections, but some can affect the kidneys.

Certain antibiotics can directly irritate or injure kidney tissue, while others are primarily eliminated through the kidneys. When kidney function is reduced, the medication may remain in the body longer than expected.

For this reason, some antibiotics require a dose adjustment based on kidney function.

The important point is that having kidney disease does not necessarily mean you cannot take antibiotics. In many cases, an appropriate antibiotic can be used safely when the dose and schedule are adjusted correctly.

If you have reduced kidney function, tell your healthcare professional before starting a new antibiotic. They can determine whether your kidney function needs to be checked and whether the medication requires a dose adjustment.

Never stop an antibiotic early or change its dose without medical advice.

3. Diuretics

Diuretics are commonly known as water pills. They help the body remove excess salt and water through urine.

They are frequently prescribed for conditions such as high blood pressure, heart failure, and fluid retention.

Examples include medications such as furosemide and hydrochlorothiazide.

Diuretics can be beneficial for people with certain kidney and heart conditions, but they can also create problems if they cause excessive fluid loss or electrolyte imbalances.

For example, taking too much of a diuretic may contribute to dehydration. Significant dehydration can reduce blood flow to the kidneys and increase the risk of acute kidney problems.

The goal is not to avoid diuretics when they are medically necessary. Instead, they should be used at the dose prescribed, with appropriate monitoring when needed.

If you experience unusual dizziness, severe weakness, very low blood pressure, or significant changes in urination while taking a diuretic, contact your healthcare professional.

4. ACE Inhibitors and ARBs

ACE inhibitors and angiotensin receptor blockers, commonly called ARBs, are widely used to treat high blood pressure and certain heart conditions.

Examples include lisinopril, enalapril, losartan, and valsartan.

This category is slightly different from some of the others on this list because these medicines can actually protect the kidneys in many people, particularly those with high blood pressure or certain types of kidney disease.

However, they can also change kidney function and increase potassium levels, especially when treatment begins or when a person’s health status changes.

The risk of kidney problems can increase when an ACE inhibitor or ARB is combined with an NSAID and a diuretic, particularly during dehydration or acute illness.

For this reason, healthcare professionals may monitor blood tests after starting or changing these medications.

If you have been prescribed an ACE inhibitor or ARB, you should not stop taking it simply because you have read that it can affect kidney function. These medications often provide important cardiovascular and kidney benefits.

5. Proton Pump Inhibitors

Proton pump inhibitors, or PPIs, are medications used to reduce stomach acid. They are commonly prescribed for acid reflux, gastroesophageal reflux disease, stomach ulcers, and other acid-related conditions.

Examples include omeprazole, pantoprazole, and lansoprazole.

PPIs are generally considered safe for many people when used appropriately. However, research has identified associations between PPI use and certain kidney problems, including a rare type of kidney inflammation known as acute interstitial nephritis.

Some observational research has also found associations between long-term PPI use and chronic kidney disease. However, an association does not prove that the medication directly caused the condition.

The best approach is to use these medications when medically appropriate and periodically review whether continued treatment is necessary.

If you have been taking a PPI for a long time, ask your healthcare professional whether you still need it and whether your treatment should be reviewed.

6. Lithium

Lithium is an important medication used primarily in the treatment of bipolar disorder and certain other psychiatric conditions.

Unlike many medications on this list, lithium requires particular attention because the kidneys play an important role in removing it from the body.

Long-term lithium treatment can affect the kidneys in some people. One possible effect is a condition in which the kidneys have difficulty concentrating urine, leading to increased urination and thirst.

Long-term exposure may also be associated with chronic kidney problems.

However, lithium can be highly effective and important for people who need it. Stopping it suddenly without medical supervision can be dangerous.

People taking lithium generally require appropriate monitoring, which may include blood tests to check lithium levels and kidney function.

Tell your healthcare professional about any new medications you take while using lithium because some medicines can alter lithium levels and increase the risk of toxicity.

7. Certain Antiviral and Antifungal Medications

Some antiviral and antifungal medicines are processed or eliminated through the kidneys and may require special consideration in people with reduced kidney function.

Certain medications in these categories can potentially cause kidney injury, particularly at higher doses or in people with existing kidney problems.

However, these medicines can be extremely important when treating serious infections. Avoiding necessary treatment because of concerns about kidney health can sometimes be more dangerous than using the medication under appropriate medical supervision.

If you have kidney disease and are prescribed an antiviral or antifungal medicine, your healthcare professional may review your kidney function and adjust the dose if necessary.

Always provide a complete list of your medications, including over-the-counter products and supplements, so potential interactions can be identified.

8. Some Medicines Used Before Medical Procedures

Certain medications and preparations used around medical procedures can also affect kidney health.

One example is some older oral sodium phosphate preparations used for bowel cleansing before colonoscopy. These products can cause significant changes in fluid and mineral balance and may pose a kidney risk in susceptible individuals.

Contrast materials used during certain imaging procedures can also require special consideration in people with impaired kidney function.

This does not mean people with kidney disease cannot undergo scans or procedures involving contrast. Medical teams can assess the individual’s kidney function and determine the safest approach.

Before a procedure, always tell the medical team if you have kidney disease or have previously experienced kidney problems.

Why Kidney Function Matters When Taking Medication

Your kidneys help remove many medicines from your body.

When kidney function decreases, certain medications may remain in the bloodstream for longer than expected. This can increase the amount of medication in the body and potentially increase side effects.

For this reason, some medicines need to be given at a lower dose or less frequently when kidney function is reduced.

A blood test commonly used to assess kidney filtration is the estimated glomerular filtration rate, or eGFR.

Knowing your eGFR can help healthcare professionals determine whether a medication is appropriate and whether its dose needs to be adjusted.

This is particularly important for people who already have chronic kidney disease.

Who May Have a Higher Risk?

Medication-related kidney problems are more likely in some situations.

You may need extra caution if you:

• Already have chronic kidney disease
• Are older
• Have diabetes
• Have high blood pressure
• Have heart failure
• Become dehydrated
• Take several medications at the same time
• Use high doses of certain pain medicines
• Have recently experienced severe vomiting or diarrhea
• Are taking medications that affect kidney blood flow
• Have previously experienced acute kidney injury

Having one of these risk factors does not mean that a medication is automatically unsafe. It simply means that medication choices and monitoring may deserve additional attention.

Signs That May Require Medical Attention

Kidney problems do not always cause obvious symptoms in their early stages. However, certain changes should not be ignored.

Contact a healthcare professional if you develop symptoms such as:

• A significant decrease in urination
• Swelling in the legs, ankles, feet, or around the eyes
• Unusual or persistent fatigue
• Shortness of breath
• Persistent nausea or vomiting
• Confusion or unusual drowsiness
• Blood in the urine
• Significant changes in urination
• Severe weakness or dizziness

These symptoms can have many possible causes, so they do not automatically mean that a medication has damaged your kidneys. Nevertheless, they deserve medical evaluation.

How to Protect Your Kidneys While Taking Medication

You can take several practical steps to reduce medication-related risks.

Keep an Updated Medication List

Write down every medication you take, including prescription drugs, over-the-counter pain relievers, vitamins, and supplements.

Bring this list to medical appointments and update it whenever something changes.

Avoid Self-Medicating With Painkillers

Over-the-counter medicines may seem harmless because they are easy to purchase, but some can affect kidney function.

Before regularly using NSAIDs, especially if you have kidney disease or other health conditions, ask a healthcare professional whether they are appropriate for you.

Stay Properly Hydrated

Dehydration can place additional stress on the kidneys, particularly when combined with certain medications.

If you are sick with vomiting, diarrhea, fever, or another condition that may cause significant fluid loss, contact your healthcare professional for advice about your medications.

Check Your Kidney Function When Recommended

People with kidney disease or other risk factors may need periodic blood and urine tests.

Regular monitoring can help identify changes before they become serious.

Tell Your Doctor About Supplements

Natural does not always mean harmless. Some herbal products and supplements may affect the kidneys or interact with medications.

Always mention supplements when discussing your medications with a healthcare professional.

Should You Stop a Medication if You’re Worried About Your Kidneys?

No—not without medical advice.

Many medications that require kidney monitoring are also essential for controlling serious health conditions.

For example, ACE inhibitors and ARBs can provide important kidney and heart benefits for certain patients. Similarly, lithium may be an essential treatment for some people with bipolar disorder.

The correct response to a potential medication risk is usually review and monitoring, not suddenly stopping treatment.

If you’re concerned that a medicine could be affecting your kidneys, speak with your doctor or pharmacist. They can determine whether you need blood tests, a dose adjustment, a different medication, or no change at all.

Final Thoughts

Medications play an important role in treating pain, infections, high blood pressure, heart disease, mental health conditions, and many other illnesses. At the same time, some medicines can affect kidney function or require dose adjustments when kidney function is reduced.

The most important medications to be aware of include NSAIDs, certain antibiotics, diuretics, ACE inhibitors and ARBs, proton pump inhibitors, lithium, certain antiviral and antifungal medicines, and some medications or preparations used around medical procedures.

However, the presence of a kidney-related risk does not mean that a medication is automatically dangerous. Many of these medicines can be used safely when prescribed appropriately and monitored when necessary.

If you have kidney disease, take several medications, or are starting a new treatment, make sure your healthcare professional knows about your complete medication list and kidney history.