Many analgesic medicines (painkillers) are available over-the-counter. While most of these medicines are safe for occasional use, their heavy or long-term use may harm the kidneys. An estimated 10 percent of the new cases of chronic kidney failure each year may be caused by overuse of these medicines.
However, kidney disease related to analgesic use is preventable. It is important to realize that, while helpful, these medicines are not completely without risk, and they should be used carefully.
WHAT ARE ANALGESICS?
Analgesics are medicines that help to control pain and to reduce fever and inflammation. Examples of analgesics that are available over-the-counter are: aspirin (Anacin, Ascriptin, Bufferin, Ecotrin, Empirin), acetaminophen (Tylenol), ibuprofen (Advil, Motrin, Nuprin) and naproxen (Aleve). Some of these medicines are also available in mixtures such as aspirin and acetaminophen, which may also have other added ingredients like codeine or caffeine. The added ingredients are usually not harmful alone, but may contribute to risk of kidney disease when taken in analgesic combinations.
I HAVE HEARD THAT ANALGESICS CAN HURT YOUR KIDNEYS. IS THAT TRUE?
Yes. Heavy long-term use of these medicines, especially if they contain a mixture of painkilling ingredients, like aspirin-acetaminophen mixtures (Excedrin, Vanquish), may harm kidney function. If you are concerned about this, please ask your doctor.
IS ASPIRIN SAFE FOR REGULAR USE?
When taken as directed, regular use of aspirin does not seem to increase the risk of kidney disease in people who have normal kidney function. However, taking too large doses (more than eight tablets a day) of aspirin may damage kidney function. People who have reduced kidney function, or other health problems such as liver disease or severe heart failure, should not use aspirin without speaking to their doctor.
MY DOCTOR RECOMMENDED THAT I TAKE AN ASPIRIN A DAY TO HELP PREVENT HEART ATTACKS. WILL THIS HURT MY KIDNEYS?
No. There is no risk to the regular use of aspirin in the small doses recommended for prevention of heart attacks.
WHAT PAINKILLERS ARE SAFE FOR PEOPLE WITH KIDNEY DISEASE?
Acetaminophen is generally recommended for occasional use by people who have kidney disease or who are at risk for developing kidney disease (such as people with diabetes or severe high blood pressure). Long-term use of acetaminophen by these patients should be discouraged. If these patients have a medical need for long-term use of acetaminophen (for example, for treating arthritis), they should be supervised by their doctor.
WHAT ARE NSAIDS? ARE THEY SAFE TO TAKE?
Nonsteroidal anti-inflammatory drugs (NSAIDS) are a group of painkillers, including drups like ibuprofen, naproxen and indomethacin. Some of them are available over-the-counter. This includes some forms of ibuprofen (Advil, Motrin, Nuprin) and naproxen (Aleve).
NSAIDs are safe when taken as directed for a limited peirod of time. However, patients with certain conditions such as underlying kidney disease, heart disease, severe high blood pressure or liver disease, and elderly patients taking diuretics, should be discouraged from taking these drugs as they may cause acute kidney failure and even progressive kidney damage.
I HAVE ARTHRITIS. WHAT PAINKILLERS CAN I TAKE THAT WON’T HURT MY KIDNEYS?
You should speak to your doctor about what the best choice is for you. Your kidney function should be monitored carefully, especially if you already have a kidney disease or are at risk for developing kidney disease (for example, if you have diabetes or severe high blood pressure). This would consist of following your serum Creatinine concentration (by means of a simple blood test) at regular intervals.
HOW DO I KNOW IF PAINKILLERS HAVE AFFECTED MY KIDNEYS?
Your doctor can check your kidneys by doing simple blood tests like BUN (blood urine nitrogen) and Serum Creatinine level. These tests measure the amount in your blood of waste products that are normally removed by your kidneys. If your kidneys are not working as well as they should, these levels will be increased in your blood. Sometimes, a urine specimen is collected over a 24-hour period to check for appearance of protein in the urine.
WHAT CAN I DO TO KEEP MY KIDNEYS HEALTHY?
Kidney disease caused by analgesics is preventable. Here are some things you can do to help your kidneys healthy:
- Avoid using painkillers in large doses or for long periods of time.
- Avoid using analgesics that contain a mixture of painkilling ingredients, like aspirin-acetaminophen mixtures.
- If you are taking analgesics, increase the amount of fluid you drink (six to eight glasses of fluid a day).
- If you have kidney disease, avoid using aspirin and NSAIDs. Long-term use of acetaminophen should be avoided, unless medically needed and supervised by your doctor.
- If you have chronic pain problem, such as arthritis, speak to your doctor about what medicine is best for you to take, and have your kidney function monitored at regular intervals.
- Make sure your doctor knows about all medicines you are taking, even over-the-counter medicines