Nephrotoxic drugs

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

# Antibiotics

## Antibacterials
- 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
- Acyclovir (only nephrotoxic in intravenous form)
- Adefovir
- Cidofovir
- Foscarnet
- Indinavir
- Tenofovir

## Antiparasitic drugs
- Chloroquine
- Hydroxychloroquine
- Pentamidine
- Quinine

# Chemotherapy and Immunosuppressants
- Cisplatin
- Cyclosporine
- Interferon alpha
- Methotrexate
- Mitomycin
- Foscarnet
- Tacrolimus

# Heavy Metals and Poisons
- 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
- Dialysis indications: serum creatinine >2.5 or seizures, rhabdomyolysis
- Chronic kidney disease with fibrosis
- Mercury poisoning
- Nitrosourea compounds

# AntiHyperlipidemics
- 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
- Carmustine
- Carboplatin
- Cisplatin
- Ifosfamide
- Causes fanconi's syndrome
- Lomustine

# Proton channel blockers
- Esomeprazole
- Lansoprazole
- Omeprazole
- Pantoprazole
- Rabeprazole

# Miscellaneous Drugs
- 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
- 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
- Cocaine
- Heroin
- Ketamine
- Methadone
- Methamphetamine

# Nephrotoxic Drugs in Alphabetical Order