The information on this page has been put together to help you understand the different drugs used to treat kidney failure, as well as guide you as to what can be taken when you have kidney disease. Always consult your GP, kidney doctor or pharmacist before changing or starting any medications.
Contents of this page:
Check the medications you are taking
If you have chronic kidney disease (CKD) you should ask your doctor to check through the drugs you are taking. This is because some drugs (e.g. metformin - for diabetes) pass out of the body by way of the kidneys, and the dose may need to be reduced if the kidneys are working less efficiently. Also, there are some drugs that are slightly toxic to the kidneys, and others that may cause problems with the levels of minerals in your blood.
Do tell your doctor if you take any tablets you buy at the chemist (without a prescription), of if you take any herbal or other alternative remedies, such as Echinacea, St John's Wort or even vitamin supplements.
Medications to avoid taking if you have CKD belongs to a family of drugs called NSAIDs (non-steroidal anti-inflammatory drugs). There are several different drugs in this class, and they are painkillers used for arthritic pain or headaches. One type, ibuprofen, can be bought from the chemist or the supermarket without prescription; check the label carefully if you are buying painkillers, as ibuprofen is sold under several different brand names (such as Advil, Brufen and Nurofen). Many people with CKD have painful conditions and can take NSAIDs with careful supervision, but it is worth talking to your doctor about alternative painkillers. Paracetamol can be used safely if you have CKD, but remember to keep to the recommended doses.
Over the counter medicines
If you have kidney disease, or have had a kidney transplant, there are sometimes problems with buying medicines over the counter (i.e. from pharmacies, supermarkets or garages) to treat minor ailments.
We have a leaflet designed to give you more information about the medicines that may cause problems.
More information on medicines (leaflets)
We have a number of leaflets about the various medicines you may be prescribed depending on your condition:-
Commonly used drugs
Most drugs, rather confusingly have two names: the real (doctors') name and the trade (company) name. So, for example, Neoral is the trade name for Ciclosporin.
On this page, the trade name will be indicated by the use of a capital first letter and inverted commas - like 'Neoral'.
Doctors tend to use the real name of the drug.
Use the following links to skip to a section:
- Antibiotics used after transplantation
- Antibiotics used to treat haemodialysis line infections
- Antibiotics to treat peritonitis in peritoneal dialysis patients
- Drugs that lower blood pressure (antihypertensive agents)
- Water tablets (diuretics)
- Drugs that control renal bone disease
- Drugs that increase your blood count (control anaemia)
- Drugs that control vasculitis
- Drugs that suppress the immune system (Immunosuppressants) after a transplant
- Drugs that thin your blood
- Drugs that reduce cholesterol in your blood ('statins')
- Drugs that reduce acid in your stomach (antacids)
- Drugs that relieve constipation
- Drugs that reduce itching (antihistamines)
- Restless legs
Antibiotics used after transplantation
- Amphotericin (prevents fungal infection)
- Co-trimoxazole (prevents a type of pneumonia called pneumocystis, or PCP or CDC)
- Isoniazid (prevents tuberculosis)
Note: these tablets can usually be stopped 6 months after a transplant.
Antibiotics used to treat haemodialysis line infections
Note: usually given as a single dose injection, then blood levels need to be measured.
Antibiotics to treat peritonitis in peritoneal dialysis patients
Note: usually given as a course, either intravenously or in the dialysis fluid; then blood levels need to be measured.
Drugs that lower blood pressure (antihypertensive agents)
- Calcium antagonists (amlodipine, felodipine, nifedipine, diltiazem, verapamil)
- Beta-blockers (atenolol, bisoprolol, propranolol)
- Alpha-blockers (doxazosin)
- ACE-inhibitors or 'Prils' (lisinopril, perindopril, ramipril)
- ARBs or 'Sartams' (losartan, candesartan, irbesartan, valsartan)
Note: all blood pressure tablets, if given in too high dosage, can cause low blood pressure and dizziness. ACE-inhibitors and ARBs can increase the potassium levels in the blood and cause or worsen kidney failure.
Water tablets (diuretics)
- Metolazone (very strong)
Note if given in too high dosage, these tablets can cause dehydration, low blood pressure and dizziness.
Spinolactone can cause the potassium levels in the blood to rise.
Drugs that control renal bone disease
- Aluminium hydroxide ('Alucaps')
- Calcium acetate ('Phosex')
- Calcium carbonate ('Calcichew')
- Sevelamer ('Renagel')
Note: these tablets have to be taken with food. Calcium carbonate and acetate can raise calcium levels.
Vitamin D tablets
Note: these tablets can also cause the calcium level in the blood to rise.
- This drug has the advantage of not raising calcium levels.
Drugs that increase your blood count (control anaemia)
- Ferrous (iron) sulphate tablets
- Iron injection
- ESA injections ('Recoron', 'Aranesp', 'Mircera')
Note: ESA injections are often given under the skin, from three times a week, to once a month. They can cause blood pressure to go up.
Drugs that control vasculitis
- Less strong: prednisolone
- Stronger: azathioprine
- Very strong: cyclophophamide
Note: all these tablets have side effects that need to be monitored regularly by your kidney doctor.
Drugs that suppress the immune system (Immunosuppressants) after a transplant
- Less strong: prednisolone
- Stronger: azathioprine or mycophenolate mofetil. Mycophenolate sodium (Mycophenolic acid; 'Myfortic') should not be confused with the similar sounding drug mycophenolate sodium (mycophenolic acid, or 'Myfortic') which must not be prescribed instead.
- Very strong: ciclosporin ('Neoral') or tacrolimus ('Prograf') or sirolimus.
Note: all these tablets have side effects that need to be monitored regularly by your kidney doctor. If you're taking any of the drugs in the 'very strong' group, you'll need to have your blood levels of the drug measured regularly too.
Drugs that thin your blood
Note: low dose aspirin (75mg once a day) is safe in kidney failure.
Drugs that reduce cholesterol in your blood ('statins')
Note: 'statins' can cause muscle pain; or cause, or worsen, kidney failure.
Drugs that reduce acid in your stomach (antacids)
- PPIs (omeprazole, lansoprazole)
- H2-antagaonis (ranitidine, cimetidine)
Note: short courses (6 weeks) are recommended.
Drugs that relieve constipation
Note: these are commonly prescribed to patients on peritoneal dialysis.
Drugs that reduce itching (antihistamines)
Note: these tablets are not that effective, and may make you drowsy. It may be better to have an increased dialysis dose.
Note: this is a sleeping tablet that has been found to be effective for restless legs.
Pain medication for people with kidney disease
The following information is also available as a downloadable leaflet: Pain medication for people with kidney disease
If you'd like to order a hard copy please see our leaflets and booklets page
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Pain is one of the most common and distressing symptoms for people with chronic kidney disease (CKD). Take care when choosing a pain killer (analgesic) as some types should not be taken by people with kidney problems or should only be used with specialist guidance. When a pain killer is prescribed for you for either acute (short term) or chronic (long term) pain, a stepwise approach is used (the analgesic ladder). This means that the weakest pain killer from the first step of the analgesic ladder is tried first. If you are still in pain, a stronger pain killer will be tried. Your pain and any side effects will be monitored closely.
This information explains the different types of pain killers recommended if you have kidney disease. This information is for older children and adults only.
What are the different types of painkillers?
The main types of pain killer are:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) e.g. ibuprofen, naproxen
- Weak opioids e.g. codeine, dihydrocodeine, tramadol
- Strong opioids e.g. morphine, oxycodone, alfentanil
- Others e.g. amitriptyline, gabapentin
The type of pain killer prescribed depends on how severe your pain is and where it is coming from.
What are the different types of pain killers?
Paracetamol in standard doses is safe to take if you have kidney problems. Opioids can be used carefully starting with small doses and increasing the dose slowly if required and only under medical supervision.
Which pain killers should I avoid?
NSAIDs should be avoided if you have chronic kidney disease or have a kidney transplant. This is because they can worsen your kidney function and cause fluid retention They may be safe to take if you are on dialysis and do not produce any urine but they can cause bleeding from the stomach and gut and should not be taken for long periods of time or if you have a a history of ulcers.
Opiates should be used very carefully as levels can build up in the body and cause side effects such as drowsiness. They can also cause nausea and constipation, which can be a significant problem if you are on peritoneal dialysis as it can result in the catheter being squashed and therefore unable to drain the fluid correctly.
Always follow your doctor’s or pharmacist’s advice about painkillers and never take more than the recommended dose.
More information about pain killers
This can be used safely in people whose kidneys are not working well. The standard dose is 500mg-1g every four-six hours, with a maximum of eight tablets in 24 hours. If you weigh less than 50kg or have liver disease you should only take 500mg every 6-8 hours. It is usual to add in another painkiller if paracetamol is not working for you.
Side effects may include liver damage with prolonged usage.
NSAIDs e.g. aspirin, ibuprofen, diclofenac, naproxen
These medications, as tablets, creams or gels, are best avoided if you have kidney disease or a kidney transplant as they can make your kidney function worse. You should therefore only take NSAIDs if they have been approved by your kidney doctor.
NSAIDs are usually taken two or three times a day, depending on the drug and preparation. Some NSAIDs are only available from your GP whereas others (e.g. ibuprofen) can be bought over the counter. Some cold medicines contain a NSAID so be careful not to take two different NSAIDs at the same time.
Side effects may include indigestion, stomach ulcers, bleeding from the gut, rash, worsening asthma, acute kidney injury, high blood pressure and fluid retention (oedema). There is also a risk of bleeding with low dose aspirin.
Weak opioids e.g. codeine
These medications are usually taken every four-six hours, with a maximum of six doses in 24 hours. People with kidney disease often only need very small doses of opioids and often get more side effects even with a small dose.
Side effects may include constipation, feeling/being sick and drowsiness. Laxatives can help with constipation but these should only be taken after discussion with your doctor or pharmacist. Try taking the pain killers with food if you feel sick. Avoid driving or operating machinery if you are feeling sleepy.
Strong opioids e.g. morphine, fentanyl, oxycodone
Morphine and oxycodone are usually taken every four-six hours. They are also available as ‘slow release’ preparations or skin patches which may be used less frequently, depending on the medicine. People with kidney disease often only need very small doses of opioids and often get more side effects even with a small dose.
Side effects may include constipation, feeling /being sick and drowsiness. Laxatives can help with constipation but these should only be taken after discussion with your doctor or pharmacist. Try taking the pain killers with food if you feel sick. Avoid driving or operating machinery if you are feeling sleepy.
Other pain killers e.g. gabapentin, amitriptyline
These pain killers are often used for neuropathic (nerve) pain. They are usually taken once or twice a day. People with kidney disease often only need very small doses of these medicines and often get more side effects even with a small dose.
Side effects may include drowsiness, anxiety and dizziness.
You should always store tablets in their original packet, in a cool, dry place and out of the sight and reach of children.
Do not get rid of any expired or unwanted medicine by flushing them down the toilet or throwing them in the bin. Take them to your local pharmacy which will dispose of them for you.
Where can I find out more information?
Talk to your GP, kidney doctor or pharmacist if you are in pain. They will be able to discuss which pain killers may be right for you. It is particularly important that you talk to them before changing or starting any medications.
Other sources of information include: