Nephrotoxic drugs: Difference between revisions
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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 Acute Tubular Necrosis) | *[[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 | ||
| 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]] | ||
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*[[Arsenic]] Poisoning | *[[Arsenic]] Poisoning | ||
*[[Bismuth]] | *[[Bismuth]] | ||
*Gold therapy | |||
*[[Lead]] Poisoning | *[[Lead]] Poisoning | ||
*[[Lithium]] related kidney disorders | *[[Lithium]] related kidney disorders | ||
| Line 82: | Line 103: | ||
:* 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]] | ||
| Line 88: | Line 110: | ||
:*:* Decreased [[Creatinine Clearance]] after 2 weeks of use | :*:* Decreased [[Creatinine Clearance]] after 2 weeks of use | ||
:*:* Changes persisted for at least 3 weeks off [[Aspirin]] | :*:* 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: [[Celecoxib]], [[Ibuprofen]], [[Naproxen]] | *[[NSAID]]s: [[Celecoxib]], [[Ibuprofen]], [[Naproxen]] | ||
:*[[Nephrotic Syndrome]] type reaction | :*[[Nephrotic Syndrome]] type reaction | ||
| Line 109: | Line 139: | ||
*[[Sulfonamide]]s | *[[Sulfonamide]]s | ||
:*[[Vasculitis]] reaction | :*[[Vasculitis]] reaction | ||
*[[Ticlopidine]] | |||
*[[Zoledronate]] | |||
==Drugs of abuse== | ==Drugs of abuse== | ||
* [[Cocaine]] | * [[Cocaine]] | ||
*[[Heroin]] | |||
*[[Ketamine]] | |||
*[[Methadone]] | |||
*[[Methamphetamine]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 14:14, 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: Creatinine >2.5 or Seizures, ALOC, 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