What Meds Hurt Kidneys?
_Antibiotics, Diuretics, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Proton Pump Inhibitors (PPIs), Supplements, Laxatives
_Antibiotics
_Some drugs can make crystals that don't break down and can block your urine flow. Others have substances that can damage certain kidney cells when they try to filter them out. Some people also have allergic reactions to antibiotics that can affect their kidneys. All these things are more likely to happen if you take antibiotics for a long time or your dose is very high.
_Diuretics
_Doctors use these medicines, also known as water pills, to treat high blood pressure and some kinds of swelling. They help your body get rid of extra fluid. But they can sometimes dehydrate you, which can be bad for your kidneys.
_Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
_Whether they're over-the-counter -- like aspirin, ibuprofen, or naproxen -- or prescribed by your doctor, you shouldn’t use them regularly for a long time or take high doses of them.
_Overuse of pain meds causes up to 5% of chronic kidney failure cases every year.
_Proton Pump Inhibitors (PPIs)
_These medications (Aciphex, Prilosec, Prevacid, Nexium) are used to treat heartburn, ulcers, and acid reflux. They lower the amount of acid in your stomach, but studies have shown that taking them for a long time can raise your chances of serious kidney problems and possibly lead to kidney failure.
Other heartburn medicines called H2 blockers (Pepcid, Tagamet, Zantac) are less likely to cause these issues.
_Supplements
_Some of these, including creatine and wormwood oil, may not be good for your kidneys.
_Laxatives
_Over-the-counter or prescription versions can leave crystals in your kidneys that may damage them or cause failure. This is especially true for ones that contain oral sodium phosphate, or OSP.
_Imaging Dye
_With a magnetic resonance imaging (MRI) or computed tomography (CT) scan, doctors sometimes use a dye to help them see a specific area of your body better. In rare cases, this dye can cause serious conditions called contrast-induced nephropathy (CIN) or nephrogenic systemic fibrosis (NSF).
Drugs that Harm the Liver
_Elevated blood levels of liver enzymes
_Many drugs cause mild elevations in blood levels of liver enzymes without symptoms or signs of hepatitis. AST, ALT, and alkaline phosphatase are enzymes that normally reside within the cells of the liver and bile ducts. Some drugs can cause these enzymes to leak from the cells and into the blood, thus elevating the blood levels of the enzymes. Examples of drugs that more commonly cause elevations of liver enzymes in the blood include the statins (used in treating high blood cholesterol levels) some antibiotics, some antidepressants, and some medications used for treating diabetes, tacrine (Cognex), aspirin, and quinidine (Quinaglute, Quinidex).
_Acute and chronic hepatitis
_Certain drugs can cause acute and chronic hepatitis (inflammation of liver cells) that can lead to necrosis (death) of the cells. Acute drug-induced hepatitis is defined as hepatitis that lasts less than 3 months, while chronic hepatitis lasts longer than 3 months. Acute drug-induced hepatitis is much more common than chronic drug-induced hepatitis.
_Examples of drugs that can cause acute hepatitis include acetaminophen (Tylenol), phenytoin (Dilantin), aspirin, isoniazid (Nydrazid, Laniazid), diclofenac (Voltaren), and amoxicillin/clavulanic acid (Augmentin).
_Examples of drugs that can cause chronic hepatitis include minocycline (Minocin), nitrofurantoin (Furadantin, Macrodantin), phenytoin (Dilantin), propylthiouracil, fenofibrate (Tricor), and methamphetamine ("ecstasy")..
_Acute liver failure
_Rarely, drugs cause acute liver failure (fulminant hepatitis). These patients are extremely ill with the symptoms of acute hepatitis and the additional problems of confusion or coma (encephalopathy) and bruising or bleeding (coagulopathy). In fact, 40% to 70% of people with fulminant hepatitis die, depending upon the cause. In the U. S., acetaminophen (Tylenol) is the most common cause of acute liver failure.
_Cholestasis
_Cholestasis is a condition in which the secretion and/or flow of bile is reduced.
Examples of drugs that have been reported to cause cholestasis include erythromycin (E-Mycin, Ilosone), chlorpromazine (Thorazine), sulfamethoxazole and trimethoprim (Bactrim; Septra), amitriptyline (Elavil, Endep), carbamazepine (Tegretol), ampicillin (Omnipen; Polycillin; Principen), ampicillin/clavulanic acid (Augmentin), rifampin (Rifadin), estradiol (Estrace; Climara; Estraderm; Menostar), captopril (Capoten), birth control pills (oral contraceptives), anabolic steroids, naproxen (Naprosyn), amiodarone (Cordarone), haloperidol (Haldol), imipramine (Tofranil), tetracycline (Achromycin), and phenytoin (Dilantin).
_Most patients with drug-induced cholestasis will recover fully within weeks after stopping the drug, but in some patients, jaundice, itching, and abnormal liver tests can last months after stopping the drug. An occasional patient can develop chronic liver disease and liver failure. Drug-induced jaundice and cholestasis lasting longer than 3 months is called chronic cholestasis.
_Steatosis (fatty liver)
_The most common causes of accumulation of fat in the liver are alcoholism and non-alcoholic fatty liver disease (NAFLD) associated with obesity and diabetes. Drugs may cause fatty liver with or without associated hepatitis. In severe cases, drug-induced fatty liver can lead to cirrhosis and liver failure.
Drugs reported to cause fatty liver include total parenteral nutrition, methotrexate (Rheumatrex), griseofulvin (Grifulvin V), tamoxifen (Nolvadex), steroids, valproate (Depakote), and amiodarone (Cordarone).
_In certain situations, fatty liver alone can be life threatening. For example, Reye's syndrome is a rare liver disease that can cause fatty liver, liver failure, and coma. It is believed to occur in children and teenagers with influenza when they are given aspirin. Another example of serious fatty liver is caused by high doses of intravenous tetracycline or amiodarone. Certain herbs (for example, the Chinese herb Jin Bu Huan, used as a sedative and pain reliever) also can cause serious fatty liver.
_Cirrhosis
_Chronic liver diseases such as hepatitis, fatty liver, or cholestasis can lead to the necrosis (death) of liver cells. Scar tissue forms as part of the healing process that is associated with the dying liver cells, and severe scarring of the liver can lead to cirrhosis.
_The most common example of drug-induced cirrhosis is alcoholic cirrhosis.
_Examples of drugs that can cause chronic liver diseases and cirrhosis include methotrexate (Rheumatrex), amiodarone (Cordarone), and methyldopa (Aldomet).
_Hepatic vein thrombosis
_Normally, blood from the intestines is delivered to the liver via the portal vein, and the blood leaving the liver for the heart is carried via the hepatic veins into the inferior vena cava (the large vein that drains into the heart). Certain drugs can cause blood clots to form (thrombosis) in the hepatic veins and in the inferior vena cava. Thrombosis of the hepatic vein and inferior vena cava can lead to an enlarged liver, abdominal pain, fluid collection in the abdomen (ascites), and liver failure.
_The most important drugs that cause Budd-Chiari syndrome are birth control pills (oral contraceptives). Birth control pills also can cause a related disease called veno-occlusive disease in which blood clots only in the smallest hepatic veins. Pyrrolizidine alkaloids found in certain herbs (e.g., borage, comfrey) also can cause veno-occlusive disease.
_What are some important examples of drug-induced liver disease?
_Acetaminophen (Tylenol)
An overdose of acetaminophen can damage the liver. Other factors that increase a person's risk for damage from acetaminophen include the fasting state, malnutrition, and concomitant administration of some other drugs such as phenytoin (Dilantin), phenobarbital, carbamazepine [(Tegretol) (anti-seizure medications)] or isoniazid [(Nydrazid, Laniazid) (anti-TB drug)].
_Statins
_Idiosyncratic liver toxicity capable of causing severe liver damage (including liver failure leading to liver transplantation) has been reported with statins. The frequency of severe liver disease caused by satins is likely in the range of 1-2 per million users.
_Nicotinic acid (Niacin)
_Niacin, like the statins, has been used to treat elevated blood cholesterol levels as well as elevated triglyceride levels. Also like the statins, niacin can damage the liver. It can cause mild transient elevations in blood levels of AST and ALT, jaundice, and, in rare instances, liver failure. Liver toxicity with niacin is dose-dependent; toxic doses usually exceed 2 grams per day. Patients with pre-existing liver diseases and those who drink alcohol regularly are at higher risk for developing niacin toxicity. The sustained-release preparations of niacin also are more likely to cause liver toxicity than the immediate-release preparations.
_Amiodarone (Cordarone)
_Amiodarone (Cordarone) is an important medication that is used to treat irregular heart rhythms such as atrial fibrillation and ventricular tachycardia. Amiodarone can cause liver damage ranging from mild and reversible liver blood enzyme abnormalities, to acute liver failure and irreversible cirrhosis. Mild liver blood test abnormalities are common and typically resolve weeks to months after stopping the drug. Serious liver damage occurs in less than 1% of patients.
Amiodarone differs from most other drugs because a substantial amount of amiodarone is stored in the liver. The stored drug is capable of causing fatty liver, hepatitis, and, more importantly, it can continue to damage the liver long after the drug is stopped. Serious liver damage can lead to acute liver failure, cirrhosis, and the need for liver transplantation.
_Methotrexate (Rheumatrex, Trexall)
_Methotrexate (Rheumatrex, Trexall) has been used for the long-term treatment of patients with severe psoriasis, rheumatoid arthritis, psoriatic arthritis, and some patients with Crohn's disease. Methotrexate has been found to be a cause of liver cirrhosis in a dose-dependent fashion. Patients with pre-existing liver diseases, obese patients, and those who drink alcohol regularly are particularly at risk of developing methotrexate-induced cirrhosis. In recent years, doctors have substantially decreased methotrexate liver damage by using low doses of methotrexate (5-15 mg) given once a week and by carefully monitoring liver blood tests during therapy. Some doctors also perform liver biopsies on patients without liver symptoms after two years (or after a cumulative dose of 4 grams of methotrexate) to look for early liver cirrhosis.
_Antibiotics
_Isoniazid (Nydrazid, Laniazid). Isoniazid has been used for decades to treat latent tuberculosis (patients with positive skin tests for tuberculosis, without signs or symptoms of active tuberculosis). Most patients with isoniazid-induced liver disease only develop mild and reversible elevations in blood levels of AST and ALT without symptoms, but approximately 0.5% to 1% of the patients develop isoniazid-induced hepatitis. The risk of developing isoniazid hepatitis occurs more commonly in older patients than younger patients. The risk of serious liver disease is 0.5% in healthy young adults, and rises to more than 3% in patients older than 50. At least 10% of the patients who develop hepatitis go on to develop liver failure and require liver transplantation. The risk of isoniazid liver toxicity is increased with chronic regular alcohol intake, and with concomitant use of other medications such as Tylenol and rifampin (Rifadin, Rimactane).
_Nitrofurantoin. Nitrofurantoin is an anti-bacterial drug that is used to treat urinary tract infections caused by many gram-negative and some gram-positive bacteria.
Nitrofurantoin can cause acute and chronic liver disease. Most commonly, nitrofurantoin causes mild and reversible elevations in blood levels of liver enzymes without symptoms. In rare instances, nitrofurantoin can cause hepatitis.
_Augmentin. Augmentin is a combination of amoxicillin and clavulanic acid. Amoxicillin is an antibiotic that is related to penicillin and ampicillin. It is effective against many bacteria such as H. influenzae, N. gonorrhea, E. coli, Pneumococci, Streptococci, and certain strains of Staphylococci, Addition of clavulanic acid to amoxicillin in Augmentin enhances the effectiveness of amoxicillin against many other bacteria that are ordinarily resistant to amoxicillin.
_Augmentin has been reported to cause cholestasis with or without hepatitis. Augmentin-induced cholestasis is uncommon, but has been implicated in hundreds of cases of clinically apparent acute liver injury. Symptoms of cholestasis (jaundice, nausea, itching) usually occur 1-6 weeks after starting Augmentin, but the onset of liver disease can occur weeks after stopping the Augmentin. Most patients recover fully in weeks to months after stopping the medication, but rare cases of liver failure, cirrhosis, and liver transplantation have been reported.
_Other antibiotics have been reported to cause liver disease. Some examples include minocycline (an antibiotic related to tetracycline), and Cotrimoxazole (a combination of sulfamethoxazole and trimethoprim).
_Nonsteroidal antiinflammatory drugs (NSAIDs)
_Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly prescribed for the bone and joint-related inflammation such as arthritis, tendinitis and bursitis. Examples of NSAIDs include aspirin, indomethacin (Indocin), ibuprofen (Motrin), naproxen (Naprosyn), piroxicam (Feldene), and nabumetone (Relafen). Approximately 30 million Americans take NSAIDs regularly!
_Patients with cirrhosis and advanced liver disease should avoid NSAIDs since they can worsen liver function (and cause kidney failure as well).
_Serious liver disease (such as hepatitis) from NSAIDs, occur rarely (in approximately 1-10 patients per 100,000 who use prescriptions). Diclofenac (Voltaren) is an example of an NSAID that has been reported to cause hepatitis slightly more frequently, in approximately 1-5 per 100,000 users of the drug. Hepatitis usually resolves completely after stopping the drug. Acute liver failure and chronic liver disease, such as cirrhosis, have been reported rarely.
_Tacrine (Cognex)
_Tacrine (Cognex) is an oral medication used for treating Alzheimer's disease. (The FDA approved tacrine in 1993.) Tacrine has been reported to cause abnormal elevations in blood liver enzymes commonly. Patients may report nausea, but hepatitis and serious liver disease are rare. Abnormal tests usually become normal after tacrine is stopped.
_Disulfiram (Antabuse)
_Disulfiram (Antabuse) is a medication occasionally prescribed to treat alcoholism. It discourages drinking by causing nausea, vomiting, and other unpleasant physical reactions when alcohol is ingested. Disulfiram has been reported to cause acute hepatitis. In rare cases, disulfiram-induced hepatitis can lead to acute liver failure and liver transplantation.
_Vitamins and Herbs
Excess intake of vitamin A, taken for years, can damage the liver. It is estimated that more than 30% of the U. S. population takes supplements of vitamin A, and some individuals are taking vitamin A at high doses that may be toxic to the liver (greater than 40,000 units/ day). Vitamin A-induced liver disease includes mild and reversible elevation in blood liver enzymes, hepatitis, chronic hepatitis with cirrhosis, and liver failure.
_The symptoms of vitamin A toxicity may include bone and muscle aches, orange discoloration of skin, fatigue, and headache. In advanced cases, patients will develop enlarged livers and spleens, jaundice, and ascites (abnormal buildup of fluid in the abdomen). Patients who drink alcohol heavily and have other preexisting liver disease are at increased risk of liver damage from vitamin A. Gradual improvement in the liver disease usually occurs after stopping vitamin A, but progressive liver damage and failure may occur in severe vitamin A toxicity with cirrhosis.
_Liver toxicity also has been reported with herbal teas. Examples include Ma Huang, Kava Kava, pyrrolizidine alkaloids in Comfrey, germander, and chaparral leaf. Amanita phylloides is a liver-toxic chemical found in poisonous mushrooms. Consumption of a single poisonous mushroom can lead to acute liver failure and death.