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Medicines That Can Harm the Kidneys
The kidneys filter many medicines out of the body, and some medicines can strain or injure them in return. This list collects the 62 medicines in our Drug Guide whose kidney toxicity is well established. For many of them the risk is small when you are well and hydrated, and much larger during illness, dehydration, or when combined with other kidney-stressing medicines. Kidneys often give few symptoms until injury is advanced, which is why blood tests matter.
Balance matters: some medicines below — blood-pressure medicines of the ACE-inhibitor and ARB families, and transplant anti-rejection medicines — protect the kidneys or the transplant long-term and appear here because their kidney effects need monitoring, not because they should be avoided.
Safety first: Never stop a prescribed medicine on your own because it appears on this list. Many of these medicines are essential, and stopping suddenly can be far more dangerous than the kidney or liver risk. If you notice a warning sign, contact your doctor or pharmacist promptly and ask whether the medicine should be reviewed.
For patients and families — in plain language
Antibiotics & Infection Medicines
- Acyclovir (Zovirax) — Given by vein without enough fluids it can form crystals inside the kidneys. Warning signs: passing less urine or back/flank pain during treatment; drinking fluids as advised protects the kidneys.
- Amikacin (Amikin) — A strong hospital antibiotic that can injure the kidney tubes, usually after several days of treatment. Warning signs: passing less urine or unusual tiredness; blood tests are checked during treatment.
- Amphotericin B (Fungizone, AmBisome) — A powerful antifungal famous for straining the kidneys and lowering potassium and magnesium. Warning signs: passing less urine, muscle weakness, or unusual tiredness; blood tests are checked often.
- Colistin (Coly-Mycin) — A last-resort antibiotic that commonly strains the kidneys during treatment. Warning signs: passing less urine, swelling, or unusual tiredness; kidney tests are followed closely.
- Fluconazole (Diflucan) — Very rarely, this antifungal can inflame the kidneys. Warning signs: passing less urine, rash, or fever during treatment.
- Gentamicin (Garamycin) — A strong antibiotic that can injure the kidney tubes, usually after several days of treatment. Warning signs: passing less urine or unusual tiredness; blood and hearing tests are checked during treatment.
- Nafcillin (Nafcil) — This hospital antibiotic can inflame the kidneys, usually after a week or more of treatment. Warning signs: passing less urine, rash, or fever during treatment.
- Piperacillin-tazobactam (Zosyn) — Can occasionally inflame the kidneys, and it raises the chance of kidney injury when given together with vancomycin. Warning signs: passing less urine, rash, or fever during treatment.
- Remdesivir (Veklury) — An antiviral given in hospital; kidney tests are checked before and during treatment because kidney strain has been reported. Warning signs: passing less urine or unusual tiredness.
- Tenofovir disoproxil fumarate (Viread) — Can strain the small tubes of the kidneys and waste phosphate, weakening bones over time. Warning signs: passing less urine, bone pain, or muscle weakness; kidney and phosphate tests are checked regularly.
- Tetracycline (Sumycin) — An older antibiotic that can strain kidneys that are already weak. Warning signs: passing less urine, nausea, or unusual tiredness.
- Tobramycin (Tobrex) — Given by vein it can injure the kidney tubes; the inhaled form reaches the kidneys far less. Warning signs: passing less urine or unusual tiredness.
- Trimethoprim-sulfamethoxazole (Bactrim, Septra) — Can raise potassium and make kidney blood tests look worse, and can occasionally injure or inflame the kidneys. Warning signs: passing less urine, swelling, rash, or fever.
- Valacyclovir (Valtrex) — Changes into acyclovir in the body and can form crystals in the kidneys, mainly at high amounts or when dehydrated. Warning signs: passing less urine or flank pain.
- Vancomycin (Vancocin) — A common hospital antibiotic that can injure the kidney tubes, especially at higher levels or combined with certain other antibiotics. Warning signs: passing less urine; levels and kidney tests are checked regularly.
- Voriconazole (Vfend) — The IV form carries an ingredient that can build up when kidneys are very weak, so tablets are preferred in that situation. Warning signs: passing less urine or unusual tiredness.
Heart & Blood Pressure Medicines
- Acetazolamide (Diamox) — Makes kidney stones more likely. Warning signs: flank or groin pain, or blood in the urine; drinking enough fluid helps.
- Azilsartan (Edarbi) — Can strain the kidneys at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Benazepril (Lotensin) — Can strain the kidneys at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Candesartan (Atacand) — Can strain the kidneys at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Captopril (Capoten) — Can strain the kidneys at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Enalapril (Vasotec) — Protects the kidneys long-term in diabetes, but can strain them at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Fosinopril (Monopril) — Can strain the kidneys at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Lisinopril (Prinivil, Zestril) — Protects the kidneys long-term in diabetes, but can strain them at first or during illnesses with dehydration, and can raise potassium. Warning signs: passing less urine, swelling, or feeling faint; blood tests are checked after starting.
- Losartan (Cozaar) — Protects the kidneys long-term in diabetes, but can strain them at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Olmesartan (Benicar) — Can strain the kidneys at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Perindopril (Aceon) — Can strain the kidneys at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Quinapril (Accupril) — Can strain the kidneys at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Ramipril (Altace) — Protects the kidneys long-term in diabetes, but can strain them at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Sacubitril-valsartan (Entresto) — Its blood-pressure component can strain the kidneys during dehydration and can raise potassium. Warning signs: passing less urine, swelling, or feeling faint; blood tests are checked after starting.
- Spironolactone (Aldactone) — Can make potassium build up, especially when your kidneys are weak or you take certain blood pressure medicines. Warning signs: muscle weakness or a slow or irregular heartbeat; blood tests are checked soon after starting.
- Telmisartan (Micardis) — Can strain the kidneys at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
- Valsartan (Diovan) — Can strain the kidneys at first or during dehydration, and can raise potassium. Warning signs: passing less urine or swelling; blood tests are checked after starting.
Digestive (GI) Medicines
- Esomeprazole (Nexium) — Rarely, this acid reducer can inflame the kidneys at any time during treatment. Warning signs: passing less urine, unusual tiredness, or a kidney blood test turning worse without another explanation.
- Lansoprazole (Prevacid) — Rarely, this acid reducer can inflame the kidneys at any time during treatment. Warning signs: passing less urine, unusual tiredness, or a kidney blood test turning worse without another explanation.
- Mesalamine (Lialda, Pentasa, Asacol) — Used long-term for bowel inflammation, it can slowly inflame the kidneys, so kidney blood tests are checked from time to time. Warning signs: passing less urine or unusual tiredness.
- Omeprazole (Prilosec) — Rarely, this acid reducer can inflame the kidneys at any time during treatment, sometimes months in. Warning signs: passing less urine, unusual tiredness, or a kidney blood test turning worse without another explanation.
- Orlistat (Xenical, Alli) — By blocking fat absorption it can make the body absorb extra oxalate, which can deposit in the kidneys. Warning signs: passing less urine or flank pain, especially if you have kidney disease or have had stones.
- Pantoprazole (Protonix) — Rarely, this acid reducer can inflame the kidneys at any time during treatment. Warning signs: passing less urine, unusual tiredness, or a kidney blood test turning worse without another explanation.
- Rabeprazole (Aciphex) — Rarely, this acid reducer can inflame the kidneys at any time during treatment. Warning signs: passing less urine, unusual tiredness, or a kidney blood test turning worse without another explanation.
- Sulfasalazine (Azulfidine) — Can rarely inflame the kidneys or form crystals when you are low on fluids. Warning signs: passing less urine, rash, or fever.
Hormone & Endocrine Medicines
- Alendronate (Fosamax) — Not usually harmful to the kidneys, but it is not recommended when kidney function is severely reduced. Warning signs: passing much less urine than usual.
- Ibandronate (Boniva) — Not usually harmful to the kidneys, but it is not recommended when kidney function is severely reduced. Warning signs: passing much less urine than usual.
- Risedronate (Actonel, Atelvia) — Not usually harmful to the kidneys, but it is not recommended when kidney function is severely reduced. Warning signs: passing much less urine than usual.
- Zoledronic acid (Reclast, Zometa) — Given by vein, it can strain the kidneys, so a kidney blood test is done before each infusion and it is avoided when kidneys are very weak. Warning signs: passing less urine.
Mental Health Medicines
- Lithium (Lithobid, Eskalith) — Used for years, it can slowly reduce kidney function and can make the kidneys pass very large amounts of urine. Warning signs: passing much more urine than usual, extreme thirst, or shakiness and confusion during a stomach illness — blood tests are followed for as long as you take it.
Neurology Medicines
- Topiramate (Topamax) — Makes kidney stones more likely. Warning signs: flank or groin pain or blood in the urine; drinking enough fluid helps.
- Zonisamide (Zonegran) — Makes kidney stones somewhat more likely. Warning signs: flank or groin pain or blood in the urine; drinking enough fluid helps.
Other Medicines
- Methotrexate (Trexall, Otrexup, Rasuvo) — At high hospital amounts it can form crystals in the kidneys; because the kidneys clear it, weak kidneys let it build up and cause other side effects. Warning signs: passing less urine, mouth sores, or unusual bruising.
Pain Relief & Fever Medicines
- Aspirin (Bayer, Ecotrin) — At ordinary pain-reliever amounts it can reduce blood flow through the kidneys like other anti-inflammatory medicines; the small daily amount taken for the heart rarely does. Warning signs: passing much less urine or swelling.
- Celecoxib (Celebrex) — Even though it is gentler on the stomach, it can still reduce blood flow through the kidneys and cause kidney injury. Warning signs: passing much less urine, swelling, or unusual tiredness.
- Diclofenac (Voltaren, Cataflam) — Can reduce blood flow through the kidneys and cause kidney injury; the gel form that goes on the skin is much gentler. Warning signs: passing much less urine, swelling, or unusual tiredness.
- Ibuprofen (Advil, Motrin) — Can reduce blood flow through the kidneys and cause kidney injury, especially if you are dehydrated, older, or also take water pills or certain blood pressure medicines. Warning signs: passing much less urine, swelling, or unusual tiredness.
- Indomethacin (Indocin) — A strong anti-inflammatory that can reduce blood flow through the kidneys and cause kidney injury. Warning signs: passing much less urine, swelling, or unusual tiredness.
- Ketorolac (Toradol) — A strong hospital pain medicine that can reduce blood flow through the kidneys and cause kidney injury. Warning signs: passing much less urine or swelling.
- Meloxicam (Mobic) — Can reduce blood flow through the kidneys and cause kidney injury. Warning signs: passing much less urine, swelling, or unusual tiredness.
- Naproxen (Aleve, Naprosyn) — Can reduce blood flow through the kidneys and cause kidney injury, especially with regular use. Warning signs: passing much less urine, swelling, or unusual tiredness.
Transplant & Immune Medicines
- Cyclosporine (Neoral, Sandimmune, Gengraf) — A transplant medicine that narrows kidney blood vessels; over time it can scar the kidneys, so blood levels and kidney tests are checked very closely. Warning signs: passing less urine, swelling, or rising blood pressure readings.
- Everolimus (Zortress, Afinitor) — Can increase protein leaking into the urine, especially alongside certain other transplant medicines. Warning signs: foamy urine or swelling; urine and blood tests are followed.
- Sirolimus (Rapamune) — Can increase the amount of protein leaking into the urine. Warning signs: foamy urine or swelling; urine and blood tests are checked after starting.
- Tacrolimus (Prograf, Envarsus, Astagraf) — A transplant medicine that narrows kidney blood vessels; over time it can scar the kidneys, so blood levels and kidney tests guide every adjustment. Warning signs: passing less urine, swelling, or tremor.
- Voclosporin (Lupkynis) — A lupus kidney medicine in the same family as tacrolimus; it can lower kidney function readings, so kidney tests are checked regularly to guide treatment. Warning signs: passing less urine or swelling.
For health professionals — clinical summary
The same medicines in clinical terms: pattern or mechanism of injury, key risk factors, and monitoring in general terms. No doses, dose adjustments or treatment protocols are given.
Antibiotics & Infection Medicines
| Medicine (brands) | Pattern / mechanism of injury | Key risk factors | Monitoring (general) |
|---|---|---|---|
| Acyclovir Zovirax | Crystal nephropathy (needle-shaped crystals obstructing tubules), mainly with rapid IV infusion and dehydration; AKI usually reversible with hydration | IV form, rapid infusion, dehydration, CKD, high amounts | Hydration status and creatinine/eGFR during IV therapy |
| Amikacin Amikin | Acute tubular injury/necrosis from proximal tubular accumulation (dose- and duration-related); non-oliguric AKI typical | Prolonged courses, high trough levels, older age, CKD, volume depletion, concurrent vancomycin, loop diuretics, or other nephrotoxins | Drug levels (trough), creatinine/eGFR during therapy, hearing/balance review |
| Amphotericin B Fungizone, AmBisome | Distal tubular injury with afferent arteriolar vasoconstriction — AKI with potassium and magnesium wasting; liposomal form is less toxic | Conventional (non-liposomal) form, high cumulative amounts, CKD, volume depletion, concurrent nephrotoxins | Creatinine/eGFR, potassium and magnesium frequently during therapy; hydration status |
| Colistin Coly-Mycin | Acute tubular injury/necrosis — among the most nephrotoxic antibiotics in current use | Older age, CKD, critical illness, high amounts, concurrent nephrotoxins | Creatinine/eGFR closely during therapy; specialist-managed dosing in kidney impairment |
| Fluconazole Diflucan | Rare acute interstitial nephritis reported; mainly noted here as a drug whose own clearance falls in kidney impairment rather than a common nephrotoxin | Prior drug hypersensitivity; prolonged therapy | Creatinine/eGFR if kidney function changes during prolonged therapy |
| Gentamicin Garamycin | Acute tubular injury/necrosis from proximal tubular accumulation (dose- and duration-related) | Prolonged courses, high trough levels, older age, CKD, dehydration, concurrent vancomycin, loop diuretics, or other nephrotoxins | Drug levels, creatinine/eGFR during therapy, hearing/balance review |
| Nafcillin Nafcil | Acute interstitial nephritis — a classic beta-lactam cause; typically after 1–3 weeks of therapy | Prolonged IV courses; prior beta-lactam hypersensitivity | Creatinine/eGFR, blood counts, and liver tests during prolonged therapy |
| Piperacillin-tazobactam Zosyn | Acute interstitial nephritis reported; its main renal issue is amplifying vancomycin-associated AKI when combined | Combination with vancomycin, prolonged courses, prior drug allergy | Creatinine/eGFR during therapy, especially when combined with vancomycin |
| Remdesivir Veklury | Proximal tubular injury reported (including Fanconi-type features); its IV carrier (cyclodextrin) accumulates in severe kidney impairment | Severe kidney impairment, critical illness, concurrent nephrotoxins | Creatinine/eGFR and liver tests before and during treatment |
| Tenofovir disoproxil fumarate Viread | Proximal tubular toxicity — Fanconi syndrome spectrum (phosphate, glucose, and protein wasting) up to AKI and gradual eGFR decline; bone effects from phosphate wasting | Older age, low body weight, CKD, concurrent ritonavir-boosted regimens or other nephrotoxins, prolonged use | Creatinine/eGFR, serum phosphate, and urine protein/glucose periodically during therapy |
| Tetracycline Sumycin | Can worsen kidney function (anti-anabolic effect raising urea); outdated/degraded product historically caused a Fanconi-type tubular injury. Other tetracyclines such as doxycycline are preferred in kidney disease | Existing CKD, use of expired product | Creatinine/eGFR and urea in patients with kidney disease |
| Tobramycin Tobrex | Acute tubular injury/necrosis from proximal tubular accumulation (systemic form); inhaled use has much lower kidney exposure | Prolonged systemic courses, high trough levels, older age, CKD, concurrent nephrotoxins | Drug levels and creatinine/eGFR during systemic therapy |
| Trimethoprim-sulfamethoxazole Bactrim, Septra | Several patterns: trimethoprim blocks tubular creatinine secretion (creatinine rises without true injury), hyperkalemia from tubular potassium blockade, true AKI, crystal nephropathy, and acute interstitial nephritis | CKD, older age, high amounts, dehydration, concurrent ACE inhibitor/ARB or potassium-sparing diuretic | Creatinine/eGFR and potassium after starting, especially in kidney disease |
| Valacyclovir Valtrex | Crystal nephropathy — it converts to acyclovir; risk mainly at high amounts and in kidney impairment or dehydration | High amounts, CKD, dehydration, older age | Creatinine/eGFR in kidney impairment; hydration advice |
| Vancomycin Vancocin | Acute tubular injury (oxidative proximal tubular toxicity), exposure-related; risk rises further combined with piperacillin-tazobactam | High exposure/prolonged courses, critical illness, CKD, obesity, concurrent piperacillin-tazobactam, aminoglycosides, or loop diuretics | AUC-guided drug levels and creatinine/eGFR during therapy |
| Voriconazole Vfend | Rare kidney injury reported with the drug itself; the IV form's carrier fluid can build up when kidneys are severely weak, so tablets are preferred then | Severe kidney impairment (IV form), critical illness | Drug levels, creatinine/eGFR, and liver tests during therapy |
Heart & Blood Pressure Medicines
| Medicine (brands) | Pattern / mechanism of injury | Key risk factors | Monitoring (general) |
|---|---|---|---|
| Acetazolamide Diamox | Sulfonamide crystal precipitation/nephrolithiasis — makes urine alkaline and lowers citrate, promoting calcium phosphate stones | Prior kidney stones, dehydration, high amounts | Symptoms review; electrolytes and kidney function during long-term use |
| Azilsartan Edarbi | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Benazepril Lotensin | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Candesartan Atacand | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Captopril Capoten | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Enalapril Vasotec | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Fosinopril Monopril | Hemodynamic AKI; hyperkalemia (partly cleared by the liver, a nuance in kidney impairment) | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Lisinopril Prinivil, Zestril | Hemodynamic AKI — efferent arteriolar dilation lowers filtration pressure, especially with volume depletion, heart failure, or renal artery narrowing; also raises potassium | Volume depletion, concurrent diuretic or NSAID ('triple whammy'), bilateral renal artery stenosis, CKD, older age | Creatinine/eGFR and potassium 1–2 weeks after starting or changing the amount, and during illness |
| Losartan Cozaar | Hemodynamic AKI; hyperkalemia — same pattern as ACE inhibitors | Volume depletion, concurrent diuretic or NSAID ('triple whammy'), renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount, and during illness |
| Olmesartan Benicar | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Perindopril Aceon | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Quinapril Accupril | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Ramipril Altace | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Sacubitril-valsartan Entresto | Hemodynamic AKI and hyperkalemia via its valsartan component; blood pressure lowering can add to filtration drop during illness | Volume depletion, concurrent diuretic or NSAID, CKD, low blood pressure | Creatinine/eGFR, potassium, and blood pressure after starting or changing the amount |
| Spironolactone Aldactone | Main renal risk is hyperkalemia from tubular potassium retention, which can precipitate or worsen AKI management in CKD; AKI risk rises combined with ACE inhibitor/ARB, potassium supplements, or TMP-SMX | CKD, diabetes, older age, concurrent ACE inhibitor/ARB, potassium supplements, dehydration | Potassium and creatinine/eGFR within days to weeks of starting or changing the amount, then periodically |
| Telmisartan Micardis | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
| Valsartan Diovan | Hemodynamic AKI; hyperkalemia | Volume depletion, concurrent diuretic or NSAID, renal artery stenosis, CKD | Creatinine/eGFR and potassium after starting or changing the amount |
Digestive (GI) Medicines
| Medicine (brands) | Pattern / mechanism of injury | Key risk factors | Monitoring (general) |
|---|---|---|---|
| Esomeprazole Nexium | Acute interstitial nephritis (class effect of PPIs), at any time during treatment | Prior drug hypersensitivity; prolonged use | Creatinine/eGFR if unexplained kidney decline occurs during treatment |
| Lansoprazole Prevacid | Acute interstitial nephritis (class effect of PPIs), at any time during treatment | Prior drug hypersensitivity; prolonged use | Creatinine/eGFR if unexplained kidney decline occurs during treatment |
| Mesalamine Lialda, Pentasa, Asacol | Chronic (and occasionally acute) interstitial nephritis — idiosyncratic, can appear months into treatment; usually slowly progressive if unrecognized | Prolonged treatment; prior drug hypersensitivity | Creatinine/eGFR periodically throughout long-term treatment, including after the first year |
| Omeprazole Prilosec | Acute interstitial nephritis — the classic modern cause; immune-mediated, can occur at any time during treatment, often without the full fever/rash/eosinophil triad; chronic use also associated with gradual CKD in observational studies | Prior drug hypersensitivity; prolonged use; older age | Creatinine/eGFR if unexplained kidney decline occurs during treatment; periodic review of continued need |
| Orlistat Xenical, Alli | Enteric hyperoxaluria — fat malabsorption increases oxalate absorption, causing calcium oxalate crystal deposition in the kidneys (oxalate nephropathy) and stones | CKD, prior kidney stones, fat malabsorption, high-oxalate diet | Creatinine/eGFR in patients with kidney disease or stone history |
| Pantoprazole Protonix | Acute interstitial nephritis (class effect of PPIs), at any time during treatment | Prior drug hypersensitivity; prolonged use | Creatinine/eGFR if unexplained kidney decline occurs during treatment |
| Rabeprazole Aciphex | Acute interstitial nephritis (class effect of PPIs), at any time during treatment | Prior drug hypersensitivity; prolonged use | Creatinine/eGFR if unexplained kidney decline occurs during treatment |
| Sulfasalazine Azulfidine | Interstitial nephritis reported; crystal nephropathy is rare and linked to poor hydration | Prolonged treatment, dehydration, prior drug hypersensitivity | Creatinine/eGFR periodically during long-term treatment; hydration advice |
Hormone & Endocrine Medicines
| Medicine (brands) | Pattern / mechanism of injury | Key risk factors | Monitoring (general) |
|---|---|---|---|
| Alendronate Fosamax | Oral bisphosphonates are rarely nephrotoxic, but they are not recommended when kidney function is severely reduced (limited safety data; the IV members of the family carry the clearer kidney risk) | Severely reduced kidney function | Creatinine/eGFR before long-term use |
| Ibandronate Boniva | Oral form rarely nephrotoxic; the IV form has case reports of kidney injury — not recommended when kidney function is severely reduced | Severely reduced kidney function, IV form, dehydration | Creatinine/eGFR before treatment |
| Risedronate Actonel, Atelvia | Oral bisphosphonates are rarely nephrotoxic, but they are not recommended when kidney function is severely reduced (limited safety data) | Severely reduced kidney function | Creatinine/eGFR before long-term use |
| Zoledronic acid Reclast, Zometa | Direct tubular toxicity — AKI risk relates to amount and infusion speed; avoided in severe kidney failure | CKD, dehydration, older age, concurrent nephrotoxins, rapid infusion | Creatinine/eGFR checked before every infusion; hydration status |
Mental Health Medicines
| Medicine (brands) | Pattern / mechanism of injury | Key risk factors | Monitoring (general) |
|---|---|---|---|
| Lithium Lithobid, Eskalith | Chronic tubulointerstitial nephropathy with long-term use (can progress to CKD); nephrogenic diabetes insipidus (collecting-duct resistance to ADH) causing polyuria; acute toxicity with dehydration or interacting drugs causes AKI | Long duration of therapy, episodes of lithium toxicity, dehydration, concurrent NSAIDs, ACE inhibitors/ARBs, or thiazide diuretics, older age | Lithium levels, creatinine/eGFR, calcium, thyroid tests, and urine volume review at regular intervals for as long as it is taken |
Neurology Medicines
| Medicine (brands) | Pattern / mechanism of injury | Key risk factors | Monitoring (general) |
|---|---|---|---|
| Topiramate Topamax | Carbonic-anhydrase effect — alkaline urine and low citrate raise calcium phosphate stone risk | Prior kidney stones, dehydration, ketogenic diet | Hydration advice; kidney review if stone symptoms occur |
| Zonisamide Zonegran | Carbonic-anhydrase effect — alkaline urine and low citrate raise kidney stone risk (somewhat less than topiramate) | Prior kidney stones, dehydration | Hydration advice; kidney review if stone symptoms occur |
Other Medicines
| Medicine (brands) | Pattern / mechanism of injury | Key risk factors | Monitoring (general) |
|---|---|---|---|
| Methotrexate Trexall, Otrexup, Rasuvo | Crystal nephropathy at high amounts (drug and metabolites precipitate in tubules, worsened by acidic urine and dehydration); the drug also accumulates when kidneys are weak, causing marrow, gut, and skin toxicity | High-amount (oncology) use, CKD, dehydration, acidic urine, concurrent NSAIDs or TMP-SMX raising levels/reducing clearance | Creatinine/eGFR before each course, drug levels in high-amount protocols, hydration and urine alkalinization in hospital protocols |
Pain Relief & Fever Medicines
| Medicine (brands) | Pattern / mechanism of injury | Key risk factors | Monitoring (general) |
|---|---|---|---|
| Aspirin Bayer, Ecotrin | Hemodynamic — only at anti-inflammatory (high) amounts; the low amounts used to protect the heart rarely affect the kidneys. Chronic heavy use historically linked to papillary necrosis | High-amount use, older age, CKD, heart failure, dehydration, combination pain products | Creatinine/eGFR if used regularly at pain-reliever amounts, especially in at-risk patients |
| Celecoxib Celebrex | Hemodynamic (prostaglandin-mediated) AKI — COX-2 selectivity does not spare the kidney; interstitial nephritis reported | Older age, CKD, heart failure, volume depletion, combination with ACE inhibitor/ARB and diuretic | Creatinine/eGFR and potassium in at-risk patients |
| Diclofenac Voltaren, Cataflam | Hemodynamic (prostaglandin-mediated) AKI; acute interstitial nephritis reported | Older age, CKD, heart failure, volume depletion, combination with ACE inhibitor/ARB and diuretic | Creatinine/eGFR and potassium when used beyond short courses or in at-risk patients |
| Ibuprofen Advil, Motrin | Hemodynamic (prostaglandin-mediated) AKI; also acute interstitial nephritis and, with chronic heavy use, papillary necrosis/chronic interstitial injury | Older age, CKD, heart failure, cirrhosis, volume depletion, concurrent ACE inhibitor/ARB plus diuretic ('triple whammy'), prolonged or high-amount use | Serum creatinine/eGFR and potassium after starting or during illness; review during any acute illness |
| Indomethacin Indocin | Hemodynamic (prostaglandin-mediated) AKI — among the more potent NSAID renal effects; interstitial nephritis reported | Older age, CKD, heart failure, dehydration, combination with ACE inhibitor/ARB and diuretic | Creatinine/eGFR and potassium during treatment in at-risk patients |
| Ketorolac Toradol | Hemodynamic (prostaglandin-mediated) AKI — potent NSAID effect | Older age, CKD, dehydration, major surgery/critical illness, combination with other kidney-stressing medicines | Creatinine/eGFR and urine output during its short, supervised courses |
| Meloxicam Mobic | Hemodynamic (prostaglandin-mediated) AKI; acute interstitial nephritis reported | Older age, CKD, heart failure, volume depletion, combination with ACE inhibitor/ARB and diuretic | Creatinine/eGFR and potassium in at-risk patients |
| Naproxen Aleve, Naprosyn | Hemodynamic (prostaglandin-mediated) AKI; acute interstitial nephritis; chronic analgesic injury with long-term heavy use | Older age, CKD, heart failure, dehydration, concurrent ACE inhibitor/ARB plus diuretic | Creatinine/eGFR and potassium with regular use or in at-risk patients |
Transplant & Immune Medicines
| Medicine (brands) | Pattern / mechanism of injury | Key risk factors | Monitoring (general) |
|---|---|---|---|
| Cyclosporine Neoral, Sandimmune, Gengraf | Acute: afferent arteriolar vasoconstriction causing hemodynamic AKI. Chronic: arteriolar hyalinosis and striped interstitial fibrosis/tubular atrophy — irreversible chronic nephrotoxicity | High trough levels, prolonged exposure, older donor kidneys, concurrent NSAIDs or other nephrotoxins, CYP3A interactions raising levels | Trough drug levels, creatinine/eGFR, potassium, magnesium, blood pressure; protocol biopsies in some programs |
| Everolimus Zortress, Afinitor | As for sirolimus: increased urine protein in some patients and potentiation of calcineurin-inhibitor nephrotoxicity when combined | Pre-existing proteinuria, combination with calcineurin inhibitors | Urine protein, creatinine/eGFR, drug levels |
| Sirolimus Rapamune | Does not directly vasoconstrict like calcineurin inhibitors, but can increase urine protein (podocyte/glomerular effect) and delay recovery from tubular injury; combined with a calcineurin inhibitor it can worsen its kidney toxicity | Pre-existing proteinuria, combination with calcineurin inhibitors, delayed graft function | Urine protein and creatinine/eGFR after starting and periodically |
| Tacrolimus Prograf, Envarsus, Astagraf | Acute hemodynamic AKI from afferent vasoconstriction; chronic arteriolar injury and interstitial fibrosis with long exposure; also tubular effects (high potassium, low magnesium) | High trough levels, prolonged exposure, concurrent nephrotoxins or interacting medicines, dehydration | Trough drug levels, creatinine/eGFR, potassium, magnesium, blood pressure |
| Voclosporin Lupkynis | Calcineurin-inhibitor pattern: hemodynamic eGFR reduction; chronic structural injury possible with long exposure — kidney function is the dosing guide | Baseline reduced eGFR, prolonged exposure, concurrent nephrotoxins | eGFR regularly (it guides continued use), blood pressure, potassium |
Frequently asked questions
Can the contrast dye used for CT scans harm the kidneys?
Iodinated contrast — the dye injected for many CT scans — is the question patients ask about most. For people with healthy kidneys the risk is considered low. When kidney function is already significantly reduced, the scanning team may take precautions such as extra fluids, using the smallest amount of contrast, or choosing a different scan. Mention any kidney disease to the scanning team beforehand.
If a medicine is cleared by the kidneys, does that mean it damages them?
No. Many medicines — digoxin, gabapentin, pregabalin, allopurinol and most antibiotics cleared this way — are simply removed from the body by the kidneys, so the amount prescribed changes in kidney disease, but they do not themselves injure the kidneys. That distinction is the most common confusion in this area. Some other medicines, such as cimetidine and dolutegravir, can even make the creatinine blood test look worse without injuring the kidney at all. Diuretics, metformin and the SGLT2 inhibitor diabetes medicines are also deliberately not on this list: diuretics can lower kidney function through fluid loss rather than toxicity and are treatments for kidney patients, metformin builds up when kidneys fail rather than damaging them, and the SGLT2 inhibitors protect the kidneys overall.
What are the warning signs that a medicine is harming my kidneys?
Kidney injury often causes few symptoms until it is advanced, which is why blood tests matter. Possible signs include passing noticeably less urine, new swelling, unusual tiredness, nausea, or a rash and fever appearing during treatment (a sign of allergic kidney inflammation with some medicines). Contact your doctor promptly if you notice these, especially after starting a new medicine or during an illness with vomiting, diarrhoea or poor fluid intake.
Should I stop a medicine on this list?
Never on your own. Many of these medicines are essential — transplant anti-rejection medicines and blood-pressure medicines that protect the kidneys long-term are on the list for balance and monitoring reasons — and stopping suddenly can be far more dangerous than the kidney risk. Ask your doctor or pharmacist to review the medicine instead.
Please note: This page is a patient-education summary, not medical advice, and it deliberately contains no doses. Medicines affect everyone differently — always follow your own prescription and talk to your doctor or pharmacist before starting, stopping or changing any medicine.