Managing Medications
with Kidney Disease

When you're diagnosed with kidney disease, it's important to manage your medications to feel your best. Your doctor may prescribe certain medications, vitamins, minerals, and supplements. You may also take over-the-counter (OTC) medications that you can buy without a prescription. All of these medications can help you maintain your body's proper balance when your kidneys aren't working as well as they should.

The medications you take and how they impact your health depend on several factors. These include your level of kidney function and stage of kidney disease, and any other health conditions you may be managing. Some people may take OTC medications for a cough or a headache without knowing the impact these medications may have on their kidneys. You should always talk to your doctor before changing your medications or adding anything new to your routine, including OTC medications.

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Common types of medications people with kidney disease may take

Your nephrologist, also known as a kidney doctor, will work closely with you and your care team to prescribe the right medications to help protect your overall health. With any new medication, it’s important to understand what it does and how to take it. Here are some common types of medications people may be prescribed with kidney disease. Your doctor will help you determine which medications are right for you.

  1. ACE inhibitors—help relax your arteries and veins to lower your blood pressure. ACE inhibitors can also help to slow the progression of kidney disease.
  2. Blood pressure medications—help lower your blood pressure and slow the progression of kidney disease. High blood pressure is the second leading cause of kidney disease.
  3. Cholesterol medications—help prevent blockages in your blood vessels. High cholesterol can cause other issues, like coronary heart disease or kidney failure.
  4. Diuretics—help rid your body of excess fluids that can raise your blood pressure or cause swelling (edema). Diuretics can also help reduce fluid levels, lower blood pressure, and control potassium levels.
  5. Erythropoietin—a hormone naturally produced by healthy kidneys to make red blood cells. Without enough erythropoietin, you could develop anemia (low red blood cell count).
  6. Sodium bicarbonate—helps balance the acid in your blood. Do not take sodium bicarbonate unless your doctor prescribes it.

Common over-the-counter medications you may take

When you’re living with kidney disease, it is important to understand how OTC medications may impact your kidney health. Remember to keep your doctor and care team aware of any medications you are taking.

Common brand names: Allegra, Benadryl, Claritin, Zyrtec

These medications require dose adjustments, so talk to your doctor before taking allergy medications. Benadryl causes more drowsiness than Allegra, Claritin, and Zyrtec. Avoid medications with decongestants, or “D” in the name, like Allegra-D.

Common brand names: Maalox, Mylanta, Nexium, Pepcid AC, Prevacid, Prilosec, Tums

Your kidneys may not be able to get rid of extra aluminum, magnesium, and sodium found in Maalox and Mylanta. Limit taking antacids to no more than two weeks. If you’re on dialysis, you may not be able to take some of these medications, so talk to your doctor.

Common brand names: Colace, Ducolax, Metamucil, MiraLAX

Colace, Ducolax, and Metamucil are generally safe for people living with kidney disease. MiraLAX must be taken with a full glass of water, so it is not recommended for people who have fluid restrictions. Talk to your doctor if you use any of these medications for more than seven days.

Common brand names: Delsym, Mucinex, Robitussin

These medications are generally safe for people living with kidney disease. Talk to your doctor if your cough does not improve within seven days—or if you develop a headache, fever, or rash.

Common brand names: Afrin, Ayr, Flonase, Sudafed, Sudafed PE

Decongestants can increase blood pressure and cause your kidneys and heart to work too hard. Saline nasal sprays like Ayr are safe alternatives to other nasal sprays, such as Afrin or Flonase, or oral decongestants, like Sudafed or Sudafed PE, for people living with kidney disease.

Common brand names: Imodium A-D, Kaopectate, Pepto Bismol

Imodium A-D is safe for people with kidney disease to use for no more than 48 hours. Avoid Kaopectate and Pepto Bismol since they may harm your kidneys further.

Common brand names: Bonine, Dramamine, Medi-Meclizine

People 65 years or older are at a higher risk of developing confusion, dry mouth, and constipation from these medications. Use only as needed.

Common brand names: Tylenol and non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil, Aleve, Alka-Seltzer, Motrin

Tylenol is generally safe to use, but NSAIDs like aspirin can cause kidney injury and should be avoided. NSAIDs are also found in many cold and flu medications, so check the label for aspirin, ibuprofen, or naproxen

Common brand names: Melatonin, Unisom

It is okay to use an occasional sleep aid, but drowsiness should be expected. Talk to your doctor before trying any new treatment for insomnia.

MAKE A MEDICATION CHEAT SHEET

Having trouble remembering which medications to take and when? Print and fill out this handy reminder sheet. 

It’s also important to keep a paper copy in case of an emergency. 
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CHOOSING OTC MEDICATIONS WITH KIDNEY DISEASE

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Essential vitamins and supplements for individuals with kidney disease

Your body needs certain nutrients to stay healthy, get energy from food, and perform essential functions. Kidney disease may impact the way your body absorbs vitamins and minerals. Eating a kidney-friendly diet may also change the number of vitamins and minerals you’re able to get from the foods you eat.

Taking certain supplements can help ensure that your body is getting what it needs to help you thrive when living with kidney disease. Your doctor will regularly monitor your blood work and prescribe key supplements to help you stay your healthiest.

What are vitamins, minerals, and supplements?

While a healthy diet can provide most of the necessary vitamins and minerals, people with kidney disease may require additional supplements. Be sure to talk to your doctor before adding any vitamins, minerals, or supplements to your routine.

  • Vitamins are organic compounds that are essential for normal growth and nutrition. They are naturally found in small amounts in food, like Vitamin D in milk.
  • Minerals help our bodies develop and function. A doctor may suggest minerals such as iron, calcium, magnesium, and zinc for deficiencies or as part of a treatment plan for certain conditions. They may also prescribe chromium, iodine, and selenium for specific health issues.
  • Supplements are products that can be added to your diet. They provide nutrients that your body may not absorb through the food you eat. This includes vitamins, minerals, and herbal supplements made from natural plant extracts or whole plants.

Common vitamins and minerals you may be taking

In a B-complex vitamin, eight different B vitamins are combined to work together for different purposes. Studies show that B vitamins can help you manage stress. B vitamins may be prescribed to people with kidney disease, depending on dietary needs.
Biotin, also known as vitamin B7, helps cells produce energy while breaking down protein, fat, and carbohydrates. People living with kidney disease and eating a low-protein, kidney-friendly diet may not be getting enough biotin and need a supplement.
Calcium is a mineral that helps support strong bones, along with vitamin D—though too much or too little calcium can be harmful. Your doctor will help determine if you need to take calcium, and in what amount. Some phosphate binders prescribed for kidney disease also contain calcium, so it’s important to follow your doctor’s exact instructions.
Folate is a B vitamin that helps produce DNA for new cells and works with vitamin B12 to produce new red blood cells. The manufactured supplement, known as folic acid, can be used to reduce the risk of cardiovascular events for people with kidney disease.
Iron is a mineral that helps raise your red blood cell count and produce more hemoglobin—a protein in red blood cells that carries oxygen to the body. Because damaged kidneys produce less erythropoietin, the hormone that stimulates red blood cell production, you may need to take iron if instructed by your doctor.
Niacin, also known as vitamin B3, helps your body use sugars and fatty acids. It also helps your cells produce energy and helps enzymes function throughout the body. Research suggests that niacin may improve dyslipidemia (abnormal lipid levels), lower serum phosphorus, and help slow the progression of kidney disease.
Pantothenic acid, or vitamin B5, helps your body produce energy and metabolize protein, fat, and carbohydrates. Your doctor may prescribe this as a supplement if you are living with kidney disease and limiting protein.
Vitamin A promotes cell and tissue development, which is important for maintaining your immune system and protecting against infection. Needing vitamin A isn’t common with kidney disease and should only be taken if prescribed by your doctor. Vitamin A can be toxic if too much is taken.
Vitamin C helps keep tissues healthy, heal wounds quickly, and prevent infections. Since some dietary sources of vitamin C are limited for people with kidney disease due to concerns about potassium, your doctor may prescribe a vitamin C supplement or multivitamin with vitamin C.
Vitamin D promotes healthy bones by helping to regulate the absorption of calcium and phosphorus and supporting your immune system. With kidney disease, your kidneys are less able to convert vitamin D into its active form for your body to use. Your doctor may prescribe vitamin D based on your lab results. People living with kidney disease should take Vitamin D only if prescribed.
Vitamin E protects cells from oxidizing and protects them from the effects of free radicals, which may help prevent heart disease and cancer. Your doctor will determine if you’re low on vitamin E and could benefit from taking it. People living with kidney disease should only take Vitamin E if prescribed.
Vitamin K helps produce blood clotting proteins, which are important for forming healthy bones. If you are often on antibiotics, you may benefit from a vitamin K supplement, as determined by your doctor. However, taking this vitamin may interfere with blood thinners. People living with kidney disease should only take Vitamin K if prescribed.

Medications to avoid with kidney disease

There are some additional medications that may need to be avoided or adjusted when you’re living with kidney disease. If you are taking any of the following medications, talk to your doctor as soon as possible. Your doctor may adjust your dosage or change your medication entirely.

  • Antacids—could cause imbalances in your body with kidney disease
  • Antibiotics or antifungals—may require changing to a kidney-friendly version
  • Diabetes medications—may need a dosage adjustment to be more kidney-friendly
  • Statins (cholesterol medication)—may require a dosage adjustment to protect your kidneys

TALK TO YOUR DOCTOR BEFORE TAKING NEW MEDICATIONS

Kidney disease can change the way your body breaks things down, so it is important to manage your medications. Your doctor should be aware of all the medications you're taking, including prescriptions, OTC medications, vitamins, and supplements.