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==Overview== | ==Overview== | ||
Nephrotoxic drugs are pharmacotherapies that can lead to a decline in renal function. The drug may need to be discontinued, or the dosing reduced when this happens. | Nephrotoxic drugs are pharmacotherapies that can lead to a decline in renal function. The drug may need to be discontinued, or the dosing reduced when this happens. | ||
==Common Nephrotoxic drugs== | |||
*[[Acetaminophen]] | |||
*[[Aspirin]] | |||
*[[H1 antagonist]] | |||
*[[Cephalosporins]] | |||
*[[Cocaine]] | |||
*[[Diuretics]] | |||
*[[NSAID]]s | |||
*[[Penicillin]]s | |||
*[[Proton pump inhibitors]] | |||
*[[Angiotensin converting enzyme inhibitor]]s | |||
*[[Statins]] | |||
==Antibiotics== | ==Antibiotics== | ||
===Antibacterials=== | |||
*[[Aminoglycosides]] (10-15% Incidence of | *[[Aminoglycosides]] (10-15% Incidence of [[acute tubular necrosis]]) | ||
:*Occurs in 10-20% patients on 7 day course | :*Occurs in 10-20% patients on 7 day course | ||
:*Results in non-oligurics; increased [[ | :*Results in non-oligurics; increased [[creatinine]] | ||
:*A single dose early in septic course is usually safe | :*A single dose early in septic course is usually safe | ||
*[[Amphotericin B]] (Incidence 80-90%) | *[[Amphotericin B]] (Incidence 80-90%) | ||
| Line 16: | Line 29: | ||
*[[Chloroquine]] | *[[Chloroquine]] | ||
*[[Erythromycin]] | *[[Erythromycin]] | ||
*[[Gentamycin]] | *[[Gentamycin]] | ||
*[[Hydroxychloroquine]] | *[[Hydroxychloroquine]] | ||
*[[Isoniazide]] | *[[Isoniazide]] | ||
*[[Levofloxacin]] | *[[Levofloxacin]] | ||
*[[Methicillin]] | *[[Methicillin]] | ||
*[[Rifampin]] | *[[Rifampin]] | ||
*[[Sulfonamides]] | *[[Sulfonamides]] | ||
*[[Tetracycline]] | *[[Tetracycline]] | ||
*[[Trimethadione]] | *[[Trimethadione]] | ||
*[[Vancomycin]] | *[[Vancomycin]] | ||
===Antivirals=== | |||
*[[Acyclovir]] (only nephrotoxic in intravenous form) | |||
*[[Adefovir]] | |||
*[[Cidofovir]] | |||
*[[Foscarnet]] | |||
*[[Indinavir]] | |||
*[[Tenofovir]] | |||
===Antiparasitic drugs=== | |||
*[[Chloroquine]] | |||
*[[Hydroxychloroquine]] | |||
*[[Pentamidine]] | |||
*[[Quinine]] | |||
==Chemotherapy and Immunosuppressants== | ==Chemotherapy and Immunosuppressants== | ||
*[[Cisplatin]] | *[[Cisplatin]] | ||
*[[Cyclosporine]] | *[[Cyclosporine]] | ||
*[[Interferon alpha]] | |||
*[[Methotrexate]] | *[[Methotrexate]] | ||
*[[Mitomycin]] | *[[Mitomycin]] | ||
| Line 41: | Line 61: | ||
== Heavy Metals and Poisons== | == Heavy Metals and Poisons== | ||
*[[Arsenic]] | *[[Arsenic]] poisoning | ||
*[[Bismuth]] | *[[Bismuth]] | ||
*[[Lead]] | *Gold therapy | ||
*[[Lead]] poisoning | |||
*[[Lithium]] related kidney disorders | *[[Lithium]] related kidney disorders | ||
:*[[Polydipsia]] and [[ | :*[[Polydipsia]] and [[nephrogenic diabetes insipidus]] | ||
:*[[Acute | :*[[Acute renal failure]] | ||
:*:*[[Dialysis]] indications: [[ | :*:*[[Dialysis]] indications: [[serum creatinine]] >2.5 or [[seizure]]s, [[rhabdomyolysis]] | ||
:*[[Chronic kidney disease]] with [[fibrosis]] | :*[[Chronic kidney disease]] with [[fibrosis]] | ||
*[[Mercury]] | *[[Mercury]] poisoning | ||
*[[Nitrosourea compounds]] | *[[Nitrosourea compounds]] | ||
| Line 55: | Line 76: | ||
*[[Fenofibrate]] (Tricor) | *[[Fenofibrate]] (Tricor) | ||
:*Increases [[serum creatinine]] without significant decrease in [[GFR]] | :*Increases [[serum creatinine]] without significant decrease in [[GFR]] | ||
:*[[Serum creatinine]] rise is reversible on stopping [[ | :*[[Serum creatinine]] rise is reversible on stopping [[fenofibrate]] | ||
*[[Gemfibrozil]] | *[[Gemfibrozil]] | ||
:*Associated with [[ | :*Associated with [[acute renal failure]] due to [[rhabdomyolysis]] | ||
*[[Statin]]s | *[[Statin]]s | ||
| Line 65: | Line 86: | ||
*[[Cisplatin]] | *[[Cisplatin]] | ||
*[[Ifosfamide]] | *[[Ifosfamide]] | ||
:* Causes [[ | :* Causes [[fanconi's syndrome]] | ||
*[[Lomustine]] | *[[Lomustine]] | ||
==Proton channel blockers== | ==Proton channel blockers== | ||
*[[ | *[[Esomeprazole]] | ||
*[[Lansoprazole]] | *[[Lansoprazole]] | ||
*[[Omeprazole]] | *[[Omeprazole]] | ||
| Line 76: | Line 97: | ||
==Miscellaneous Drugs== | ==Miscellaneous Drugs== | ||
* Chronic stimulant [[ | * Chronic stimulant [[laxative]] use | ||
:* Resulting chronic volume depletion and [[ | :* Resulting chronic volume depletion and [[hypokalemia]] causes [[nephropathy]] | ||
* [[Radiocontrast agents]] | * [[Radiocontrast agents]] | ||
* [[ACE Inhibitor]]s | * [[ACE Inhibitor]]s | ||
:* Expect an increase of [[serum creatinine]] in [[chronic kidney disease]] | :* Expect an increase of [[serum creatinine]] in [[chronic kidney disease]] | ||
*[[Acetaminophen]] | *[[Acetaminophen]] | ||
*[[Amitriptyline]] | |||
*[[Anticoagulants]] | *[[Anticoagulants]] | ||
*[[Allopurinol]] | *[[Allopurinol]] | ||
*[[Aspirin]] | *[[Aspirin]] | ||
:* Low dose [[ | :* Low dose [[aspirin]] reduces [[renal function]] in elderly | ||
:*:* Decreased [[ | :*:* Decreased [[creatinine clearance]] after 2 weeks of use | ||
:*:* Changes persisted for at least 3 weeks off [[ | :*:* Changes persisted for at least 3 weeks off [[aspirin]] | ||
*Aristocholic acid containing Chinese herbals | |||
*[[Bevacizumab]] | *[[Bevacizumab]] | ||
*[[Carbon tetrachloride]] | *[[Carbon tetrachloride]] | ||
*[[Cimetidine]] | *[[Cimetidine]] | ||
*[[Ciprofloxacin]] | *[[Ciprofloxacin]] | ||
*[[Clopidogrel]] | |||
*[[Dilantin]] | *[[Dilantin]] | ||
*[[Diuretic]]s | *[[Diuretic]]s | ||
:*[[Thiazide]]s | :*[[Thiazide]]s | ||
:*[[Furosemide]] | :*[[Furosemide]] | ||
:*[[Triamterene]] | |||
*[[Doxepin]] | |||
*[[Fluoxetine]] | |||
*[[H1 antagonist]]s | |||
:*[[Diphenhydramine]] | |||
:*[[Doxylamine]] | |||
*[[Infliximab]] | *[[Infliximab]] | ||
*[[Interferon]]s | *[[Interferon]]s | ||
*[[Mesalamine]] (Asacol, Pentasa) | *[[Mesalamine]] (Asacol, Pentasa) | ||
:*[[Mesalamine]] is an [[NSAID]] analog and has systemic absorption from the bowel | |||
*[[NSAID]]s: [[ | *[[NSAID]]s: [[celecoxib]], [[ibuprofen]], [[naproxen]] | ||
:*[[Nephrotic | :*[[Nephrotic syndrome]] type reaction | ||
*[[Penicillin]]s and [[ | *[[Penicillin]]s and [[cephalosporin]]s | ||
*[[Pamidronate]] | *[[Pamidronate]] | ||
*[[Propylthiouracil]] | *[[Propylthiouracil]] | ||
| Line 108: | Line 138: | ||
*[[Rifampin]] | *[[Rifampin]] | ||
*[[Sulfonamide]]s | *[[Sulfonamide]]s | ||
:*[[Vasculitis]] reaction | :*[[Vasculitis]] reaction | ||
*[[Ticlopidine]] | |||
*[[Zoledronate]] | |||
==Drugs of abuse== | ==Drugs of abuse== | ||
*[[Cocaine]] | |||
*[[Heroin]] | |||
*[[Ketamine]] | |||
*[[Methadone]] | |||
*[[Methamphetamine]] | |||
==Nephrotoxic Drugs in Alphabetical Order== | |||
{{MultiCol}} | |||
* [[ACE Inhibitor]]s | |||
* [[Acetaminophen]] | |||
* [[Acyclovir]] | |||
* [[Adefovir]] | |||
* [[Allopurinol]] | |||
* [[Aminoglycosides]] | |||
* [[Amitriptyline]] | |||
* [[Amphotericin B]] | |||
* [[Angiotensin converting enzyme inhibitor]]s | |||
* [[Anticoagulants]] | |||
* [[Aristocholic acid containing Chinese herbals]] | |||
* [[Arsenic]] poisoning | |||
* [[Aspirin]] | |||
* [[Bevacizumab]] | |||
* [[Bismuth]] | |||
* [[Carbon tetrachloride]] | |||
* [[Carboplatin]] | |||
* [[Carmustine]] | |||
* [[Celecoxib]] | |||
* [[Cephalosporins]] | |||
* [[Chloroquine]] | |||
* [[Cidofovir]] | |||
* [[Cimetidine]] | |||
* [[Ciprofloxacin]] | |||
* [[Cisplatin]] | |||
* [[Clopidogrel]] | |||
* [[Cocaine]] | * [[Cocaine]] | ||
* [[Cyclosporine]] | |||
* [[Dilantin]] | |||
* [[Diphenhydramine]] | |||
* [[Diuretics]] | |||
* [[Doxepin]] | |||
* [[Doxylamine]] | |||
* [[Erythromycin]] | |||
* [[Esomeprazole]] | |||
* [[Fenofibrate]] (Tricor) | |||
* [[Fluoxetine]] | |||
* [[Foscarnet]] | |||
* [[Furosemide]] | |||
* [[Gemfibrozil]] | |||
* [[Gentamycin]] | |||
* [[Gold]] therapy | |||
* [[H1 antagonist]] | |||
* [[Heroin]] | |||
* [[Hydroxychloroquine]] | |||
{{ColBreak}} | |||
* [[Ibuprofen]] | |||
* [[Ifosfamide]] | |||
* [[Indinavir]] | |||
* [[Infliximab]] | |||
* [[Interferon alpha]] | |||
* [[Interferon]]s | |||
* [[Isoniazide]] | |||
* [[Ketamine]] | |||
* [[Lansoprazole]] | |||
* [[Laxative]] use | |||
* [[Lead]] poisoning | |||
* [[Levofloxacin]] | |||
* [[Lithium]] | |||
* [[Lomustine]] | |||
* [[Mercury]] poisoning | |||
* [[Mesalamine]] (Asacol, Pentasa) | |||
* [[Methadone]] | |||
* [[Methamphetamine]] | |||
* [[Methicillin]] | |||
* [[Methotrexate]] | |||
* [[Mitomycin]] | |||
* [[Naproxen]] | |||
* [[Nitrosourea compounds]] | |||
* [[NSAID]]s | |||
* [[Omeprazole]] | |||
* [[Pamidronate]] | |||
* [[Pantoprazole]] | |||
* [[Penicillin]]s | |||
* [[Pentamidine]] | |||
* [[Propylthiouracil]] | |||
* [[Proton pump inhibitors]] | |||
* [[Quinine]] | |||
* [[Rabeprazole]] | |||
* [[Radiocontrast agents]] | |||
* [[Rifampin]] | |||
* [[Statins]] | |||
* [[Sulfonamides]] | |||
* [[Tacrolimus]] | |||
* [[Tenofovir]] | |||
* [[Tetracycline]] | |||
* [[Thiazide]]s | |||
* [[Ticlopidine]] | |||
* [[Triamterene]] | |||
* [[Trimethadione]] | |||
* [[Vancomycin]] | |||
* [[Zoledronate]] | |||
{{EndMultiCol}} | |||
==References== | ==References== | ||
Latest revision as of 16:16, 10 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Aarti Narayan, M.B.B.S [3]
Overview
Nephrotoxic drugs are pharmacotherapies that can lead to a decline in renal function. The drug may need to be discontinued, or the dosing reduced when this happens.
Common Nephrotoxic drugs
- Acetaminophen
- Aspirin
- H1 antagonist
- Cephalosporins
- Cocaine
- Diuretics
- NSAIDs
- Penicillins
- Proton pump inhibitors
- Angiotensin converting enzyme inhibitors
- Statins
Antibiotics
Antibacterials
- Aminoglycosides (10-15% Incidence of acute tubular necrosis)
- Occurs in 10-20% patients on 7 day course
- Results in non-oligurics; increased creatinine
- A single dose early in septic course is usually safe
- Amphotericin B (Incidence 80-90%)
- Ciprofloxacin
- Chloroquine
- Erythromycin
- Gentamycin
- Hydroxychloroquine
- Isoniazide
- Levofloxacin
- Methicillin
- Rifampin
- Sulfonamides
- Tetracycline
- Trimethadione
- Vancomycin
Antivirals
Antiparasitic drugs
Chemotherapy and Immunosuppressants
Heavy Metals and Poisons
- Polydipsia and nephrogenic diabetes insipidus
- Acute renal failure
- Dialysis indications: serum creatinine >2.5 or seizures, rhabdomyolysis
- Chronic kidney disease with fibrosis
- Mercury poisoning
- Nitrosourea compounds
AntiHyperlipidemics
- Fenofibrate (Tricor)
- Increases serum creatinine without significant decrease in GFR
- Serum creatinine rise is reversible on stopping fenofibrate
- Associated with acute renal failure due to rhabdomyolysis
Chemotherapy
- Causes fanconi's syndrome
Proton channel blockers
Miscellaneous Drugs
- Chronic stimulant laxative use
- Resulting chronic volume depletion and hypokalemia causes nephropathy
- Expect an increase of serum creatinine in chronic kidney disease
- Low dose aspirin reduces renal function in elderly
- Decreased creatinine clearance after 2 weeks of use
- Changes persisted for at least 3 weeks off aspirin
- Low dose aspirin reduces renal function in elderly
- Aristocholic acid containing Chinese herbals
- Bevacizumab
- Carbon tetrachloride
- Cimetidine
- Ciprofloxacin
- Clopidogrel
- Dilantin
- Diuretics
- Infliximab
- Interferons
- Mesalamine (Asacol, Pentasa)
- Mesalamine is an NSAID analog and has systemic absorption from the bowel
- Nephrotic syndrome type reaction
- Vasculitis reaction
Drugs of abuse
Nephrotoxic Drugs in Alphabetical Order