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

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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

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* Acetaminophen
* Aspirin
* H1 antagonist
* Cephalosporins
* Cocaine
* Diuretics
* NSAIDs
* Penicillins
* Proton pump inhibitors
* Angiotensin converting enzyme inhibitors
* Statins

## Antibiotics

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### Antibacterials

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* 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

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

### Antiparasitic drugs

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* Chloroquine
* Hydroxychloroquine
* Pentamidine
* Quinine

## Chemotherapy and Immunosuppressants

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

## Heavy Metals and Poisons

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* 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

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* 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

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* Carmustine
* Carboplatin
* Cisplatin
* Ifosfamide

* Causes fanconi's syndrome

* Lomustine

## Proton channel blockers

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* Esomeprazole
* Lansoprazole
* Omeprazole
* Pantoprazole
* Rabeprazole

## Miscellaneous Drugs

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* 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

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* Cocaine
* Heroin
* Ketamine
* Methadone
* Methamphetamine

## Nephrotoxic Drugs in Alphabetical Order

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* 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

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## References

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