Nephrotoxic drugs: Difference between revisions
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==Drugs of abuse== | ==Drugs of abuse== | ||
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*[[Heroin]] | *[[Heroin]] | ||
*[[Ketamine]] | *[[Ketamine]] | ||
Revision as of 14:41, 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, 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