Nephrotoxic drugs

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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

• Acyclovir (only nephrotoxic in intravenous form)
• Adefovir
• Cidofovir
• Foscarnet
• Indinavir
• Tenofovir

Antiparasitic drugs

• Chloroquine
• Hydroxychloroquine
• Pentamidine
• Quinine

Chemotherapy and Immunosuppressants

• Cisplatin
• Cyclosporine
• Interferon alpha
• Methotrexate
• Mitomycin
• Foscarnet
• Tacrolimus

Heavy Metals and Poisons

• Arsenic poisoning
• Bismuth
• Gold therapy
• Lead poisoning
• Lithium related kidney disorders

• 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

• Gemfibrozil

• Associated with acute renal failure due to rhabdomyolysis

• Statins

Chemotherapy

• Carmustine
• Carboplatin
• Cisplatin
• Ifosfamide

• Causes fanconi's syndrome

• Lomustine

Proton channel blockers

• Esomeprazole
• Lansoprazole
• Omeprazole
• Pantoprazole
• Rabeprazole

Miscellaneous Drugs

• Chronic stimulant laxative use

• Resulting chronic volume depletion and hypokalemia causes nephropathy

• Radiocontrast agents
• ACE Inhibitors

• Expect an increase of serum creatinine in chronic kidney disease

• Acetaminophen
• Amitriptyline
• Anticoagulants
• Allopurinol
• Aspirin

• 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

• Aristocholic acid containing Chinese herbals
• Bevacizumab
• Carbon tetrachloride
• Cimetidine
• Ciprofloxacin
• Clopidogrel
• Dilantin
• Diuretics

• Thiazides
• Furosemide
• Triamterene

• Doxepin
• Fluoxetine
• H1 antagonists

• Diphenhydramine
• Doxylamine

• Infliximab
• Interferons
• Mesalamine (Asacol, Pentasa)

• Mesalamine is an NSAID analog and has systemic absorption from the bowel

• NSAIDs: celecoxib, ibuprofen, naproxen

• Nephrotic syndrome type reaction

• Penicillins and cephalosporins
• Pamidronate
• Propylthiouracil

• Hypersensitivity (fever, rash, arthralgia)

• Rifampin
• Sulfonamides

• Vasculitis reaction

• Ticlopidine
• Zoledronate

Drugs of abuse

• Cocaine
• Heroin
• Ketamine
• Methadone
• Methamphetamine

Nephrotoxic Drugs in Alphabetical Order

ACE Inhibitors Acetaminophen Acyclovir Adefovir Allopurinol Aminoglycosides Amitriptyline Amphotericin B Angiotensin converting enzyme inhibitors Anticoagulants Aristocholic acid containing Chinese herbals Arsenic poisoning Aspirin Bevacizumab Bismuth Carbon tetrachloride Carboplatin Carmustine Celecoxib Cephalosporins Chloroquine Cidofovir Cimetidine Ciprofloxacin Cisplatin Clopidogrel Cocaine Cyclosporine Dilantin Diphenhydramine Diuretics Doxepin Doxylamine Erythromycin Esomeprazole Fenofibrate (Tricor) Fluoxetine Foscarnet Furosemide Gemfibrozil Gentamycin Gold therapy H1 antagonist Heroin Hydroxychloroquine

Ibuprofen Ifosfamide Indinavir Infliximab Interferon alpha Interferons Isoniazide Ketamine Lansoprazole Laxative use Lead poisoning Levofloxacin Lithium Lomustine Mercury poisoning Mesalamine (Asacol, Pentasa) Methadone Methamphetamine Methicillin Methotrexate Mitomycin Naproxen Nitrosourea compounds NSAIDs Omeprazole Pamidronate Pantoprazole Penicillins Pentamidine Propylthiouracil Proton pump inhibitors Quinine Rabeprazole Radiocontrast agents Rifampin Statins Sulfonamides Tacrolimus Tenofovir Tetracycline Thiazides Ticlopidine Triamterene Trimethadione Vancomycin Zoledronate

References

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