5 common medicines that can damage kidneys and what are the alternatives

Kidneys quietly do a lot of heavy lifting, they filter waste, balance fluids, control blood pressure, and more. But sometimes, medicines meant to help us can backfire and harm these vital organs. In India, the burden of chronic kidney disease (CKD) is growing fast: according to a recent study published in The Lancet, about 138 million Indians are estimated to have CKD in 2023.

Between 2018 and 2023, the prevalence among adults rose to approximately 16.4 %, up from about 11.2% a few years ago, as per a study published in the NIH. Take a closer look




This is important, not just because kidney disease is common, but because for many people, it's silent until things go very wrong. Part of the problem is drug-induced damage. Certain medications can stress or injure the kidneys, especially if used long-term or without careful monitoring, and since kidney damage is not reversible, it can also be fatal.

There are six distinct categories of medications that are widely recognized for their potential to cause harm to the kidneys. This section will explore how these medications can exert their detrimental effects and what specific symptoms or signs one should be vigilant about.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Pain relief medications, including ibuprofen, naproxen, diclofenac, and a variety of other non-steroidal anti-inflammatory drugs (NSAIDs), are commonly utilized for their effectiveness. These medications provide significant relief from discomfort, but it is important to recognize that they also inhibit the synthesis of prostaglandins. Prostaglandins are crucial molecules that play a beneficial role in widening blood vessels within the kidneys. A study conducted by the National Institutes of Health (NIH) highlights this critical relationship. When the production of prostaglandins is reduced, it can result in a decrease in blood flow to the kidneys, which becomes particularly concerning in situations where an individual is either dehydrated or has a diminished blood volume. Such conditions can ultimately lead to acute kidney injury, raising serious health issues.

Long-term use can trigger chronic damage: NSAIDs may cause interstitial nephritis (inflammation in the kidney), papillary necrosis, or even gradual decline in kidney function. A pharmacovigilance study in India even linked extended NSAID use with chronic kidney disease.

Dr Umesh Gupta, Director Nephrology, Aakash Healthcare, said, "Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), while useful for pain relief can damage the kidneys by reducing blood flow to the kidneys when taken regularly and in high doses. It is best to use them only when needed and at the lowest effective dose for the shortest time possible."

Risk factors: older age, dehydration, existing kidney disease, heart failure, or using other drugs that affect kidney perfusion.

Advice: It is recommended to utilize the lowest effective dose of NSAIDs for the briefest period necessary. Additionally, if you find yourself in need of these medications regularly, it is essential to consult with a healthcare professional.

Aminoglycoside antibiotics

Aminoglycosides are a class of antibiotics (like gentamicin, tobramycin, amikacin) used for serious bacterial infections.

These drugs accumulate in the proximal tubule cells of the kidney. Over time, they generate reactive oxygen species (free radicals), damaging those cells and causing necrosis. Once the drug is stopped, kidney function often recovers, but not always completely, especially with higher cumulative doses or long therapy.

Risk factors: dehydration, existing CKD, liver disease, low albumin, or when used together with other nephrotoxic drugs.

The initial signs that indicate potential kidney toxicity linked to the use of aminoglycoside antibiotics may present themselves through a rise in creatinine levels in the bloodstream, a reduction in urine production, and imbalances in electrolyte levels. Consequently, it becomes imperative to implement thorough and ongoing monitoring to ensure that these early indicators are identified quickly and effectively.

Tip: When aminoglycosides are necessary, clinicians often monitor drug levels, adjust dose, ensure good hydration, and avoid other harmful drugs. Aminoglycoside antibiotics can damage kidney tubule cells by generating free radicals, making careful dosing and monitoring essential to prevent toxicity.

Vancomycin and other glycopeptides

Vancomycin is a powerful antibiotic often used to treat resistant bacterial infections. But it's not harmless: it has a known risk of kidney toxicity, especially when used at high doses or combined with other nephrotoxins (like aminoglycosides).

The underlying mechanism is not always straightforward. There are times when the patient's pre-existing condition, such as sepsis, plays a significant role in the overall situation. However, it is important to note that vancomycin, on its own, has been shown to elevate the risk of developing acute kidney injury.

Risk factors: high trough levels, prolonged therapy, and co-use of other kidney-stressing drugs.

Tip: Drug dosing needs precision, and kidney function should be monitored closely during therapy.

Also Read: Kidney health: 3 common (and dangerous) mistakes that over time can damage the kidneys

Radiocontrast agents

Contrast dyes used in imaging (CT scans, angiography) can sometimes spark contrast-induced nephropathy. These agents can reduce kidney blood flow, generate oxidative stress, and cause direct tubular toxicity. This is especially risky if someone already has impaired kidney function or is dehydrated.

Risk factors: diabetes, existing CKD, dehydration, repeated contrast exposures.

Tip: Before any diagnostic scan that uses dye, discuss your kidney health. Preventive measures include hydration, using the lowest contrast dose, and possibly alternative imaging strategies.

Drugs that affect kidney hemodynamics (ACE Inhibitors / ARBs Combined with Other Risks)

ACE inhibitors (like lisinopril) and ARBs (like losartan) are often life-saving drugs for hypertension, heart failure, and kidney disease, but under certain conditions, they can worsen kidney function transiently. These medicines dilate the efferent arteriole (part of the kidney’s blood filter), which lowers glomerular pressure. In most cases, that’s beneficial, but if combined with dehydration, NSAIDs, diuretics, or sudden drop in blood volume, it can contribute to acute kidney injury.

Although this kind of decline is often reversible, it requires close monitoring.

Adding to this Dr Gupta said, "ACE inhibitors and ARBs, such as lisinopril, enalapril, and ramipril, help regulate excessive blood pressure and protect the heart. They too can occasionally cause renal impairment, particularly if you are dehydrated or on other kidney-damaging medications. Diuretics drain excess fluid from the body and are often used to treat high blood pressure and edema. However, if not utilized properly, they can cause dehydration, putting stress on the kidneys and perhaps causing damage."

Tip: Never stop these medicines abruptly, but always inform your doctor if you’re vomiting, dehydrated, or taking other high-risk drugs.

What we need to know

Hidden risk in “safe” meds: Over-the-counter painkillers (NSAIDs) are often underestimated. People think they’re harmless, but over time and especially in vulnerable individuals, they can quietly erode kidney function.

Synergy of harm: It’s not just one drug, the real damage often happens when multiple “almost safe” medicines interact (for example, NSAIDs + ACE inhibitors + diuretics).

Individuals who rely on long-term painkillers might not even be aware that their kidneys are enduring significant strain, as the initial signs of distress can be quite subtle and easily overlooked. By empowering patients with crucial knowledge about this issue—especially in a country like India, where self-medication is a prevalent practice—there is great potential to avert a considerable amount of silent harm and adverse effects on kidney health.


Disclaimer: This article is for educational purposes only and does not replace medical advice. Always consult a qualified healthcare professional before changing or stopping any medication, especially if you have existing kidney issues or other health concerns.

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