Patient Getting Smart About Medications Education If the kidneys are not working well, less waste is removed, including

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Claud Stafford
5 years ago
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If the kidneys are not working well, less waste is removed, including medications. As your kidney function decreases, it is important to be smart about your medications.

Then the kidneys filter these waste products from the blood, dissolving them into urine.

For example, a person with kidney problems taking too much of a pain killer may be at risk for falls. People with kidney function must take these three steps to ensure medication safety: 1.

1 If the kidneys are not working well, less waste is removed, including medications. As your kidney function decreases, it is important to be smart about your medications. The liver and kidneys remove almost all medications and other waste products from the body. First, the liver dissolves these medications and waste products in water. Then the kidneys filter these waste products from the blood, dissolving them into urine. If the kidneys are not working well, less waste is removed, including medications, which may rise above safe levels over time and become toxic to the body or create unwanted side effects. For example, a person with kidney problems taking too much of a pain killer may be at risk for falls. People with kidney function must take these three steps to ensure medication safety: 1. Confirm that the medication is safe and is the right dose for you by reviewing all of your medications with your doctor or pharmacist. Remember that safety is always first. Do not take medications and other substances that may damage the kidneys or decrease their function without direction from your doctor. 2. Ensure that you take medications in the right way. Since your kidneys may not be removing enough of the medication, make sure you follow your doctor s directions closely. Inform all your doctors that you have kidney disease to make sure the right medication is being prescribed. Knowing that you are taking the right medication in the right manner will improve your use of these therapies. 3. Keep track of all your medications. Work with your care partner to create a plan of when to take all your medications that fits into your daily activities. Most pharmacies sell medication organizer boxes to help organize all your medications according to the day of the week and the time of day at which you need to take each medication. Keep your medication organizers by your kitchen table where you will be reminded of your medications each day. Ask your pharmacist for tips to improve your medication use plan. This prevents skipping medications and improves your health. The simplest way to keep track of your medications is to make a medication list. Ask your doctor, nurse or pharmacist to help you create this medication list. This way, everyone who takes care of your health will know what medications you take. Be sure to include all medications, even those you buy without a prescription, herbal products, alternative medications, vitamins, and any over-the-counter (OTC) medications. Page 1 of 5

2 The table below outlines common medications and concerns as a person progress through the stages of CKD. Confirm that the medication is safe and is the right dose for you. Stage Description Common concern 1 Kidney damage with normal or increasing 2 Kidney damage with mildly 3 Moderate <=90 Regular screening for CKD is very important for people with risk for developing CKD, such as people with diabetes, high blood pressure, smoking, urinary tract infections, and urinary stones. Avoid prolonged use of large doses of ibuprofen, indometacin, and naproxen, some antibiotics such as aminoglycosides, amphotericin B, cyclosporine, tacrolimus and tenofovir, or herbal preparation such as Bluberry Spice, Aloe, Autumn Crocus, Buckthorn, Cascara, Guang Fan Ji, Horse Chestnut, Juniper berries, Licorice Root, Periwinkle, Rhubarb, Sassafras and Wormwood plant Some medication called ACE-inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs) have been shown to slow the onset of kidney disease. Avoid dehydration and the use of metformin and Iodinated contrast dyes, products containing heavy metals such as aluminum, lead and cadmium and over the counter products like sodium phosphate enemas. If you have had a heart attack, make sure that you are taking a coated baby aspirin daily with your largest meal. Ask your doctor if your cholesterol levels are fine. If your levels are high you may need a class of drug called statins. If you have diabetes, make sure that your blood sugar is well controlled and that you are taking your diabetes medications correctly. Always keep a ready supply of sugar, such as a glucose tube or candy available in case your blood sugar drops too low. Page 2 of 5

3 Stage Description Common concern Keep your medication organizers by your kitchen table where you will be reminded of your medications each day. 4 Severely 5 Kidney failure By this stage, you may be taking 3-4 different blood pressure drugs. Other drugs commonly taken are phosphate binders, and an iron supplement. <15 or on dialysis By this time, you may be taking insulin and an oral anti-diabetic drug, several blood pressure medications, phosphate binders, injectable vitamin D, an iron supplement and an anemia drug such as erythropoietin. Your total number of medications may be drugs. It is very useful to keep an up to date list of all your medications. The table below outlines common medications and concerns as a person progress through the stages of CKD/ESRD. Commonly Dispensed Medication RENAGEL (sevelamer) PHOSLO (Calcium salt) FOLIC ACID NORVASC (amlodipine) SENSIPAR (cinacalcet) NEPHRO-VITE PREVACID (lansoprazole) TOPROL (metoprolol) PLAVIX (clopidogrel) ASPIRIN FOSRENOL (lanthanum carbonate) RENAL SOFTGEL ZESTRIL/PRINIVIL (lisinopril) TENORMIN (atenolol) CATAPRESS (clonidine) REGLAN (metoclopramide) PROTONIX (pantoprazole) Medication Use Supplement High calcium drug Renal multivitamin supplement Anti-coagulant Anti-coagulant Renal multivitamin supplement Gastric stimulant Page 3 of 5

4 The table below outlines common medications and concerns as a person progress through the stages of CKD/ESRD. Keep track of all medications, even those you buy without a prescription, including herbal products, alternative medications, and vitamins. Commonly Dispensed Medication LIPITOR (atorvastatin) ZOCAR (simvastatin) LASIX (furosemide) COLACE (docusate) VICODIN (hydrocodone/acetaminophen) COZAAR (losartan) NEXIUM (esomeprazole) RENA-VITE OTC GLUCOTROL (glipizide) PRILOSEC OTC (omeprazole) LONITEN (minoxidil) PROCARDIA (nifedipine) NORMODYNE (labetalol) NEURONTIN (gabapentin) DEXFOL ZYLOPRIM (allopurinol) IMDUR (isosorbide mononitrate) ZANTAC (ranitidine) DIOVAN (valsartan) Medication Use Cholesterol medication Cholesterol medication Diuretic Stool softener Narcotic pain medication Renal vitamin supplement Oral anti-diabetic Diabetic neuropathy medication Multivitamin supplement Gout medication The table below outlines OTC medications that should be avoided in patients with CKD/ESRD. OTC Medication Medication use Prolonged use of large doses of non steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), aspirin and naproxen (Aleve) Prolonged use of large doses of acetaminophen (Tylenol) Herbal preparations such as Blueberry Spice, Aloe, Autumn Crocus, Buckthorn, Cascara, Guang Fan Ji, Horse Chestnut, Juniper berries, Licorice Root, Periwinkle, Rhubarb, Sassafras and Wormwood plant. Pain Pain Various uses not FDA approved Page 4 of 5

5 Inform all your doctors that you have kidney disease to make sure the right medication is being prescribed. The table below outlines OTC medications that should be avoided in patients with CKD/ESRD. OTC Medication Oral sodium phosphate enemas Fleet enemas Potassium salts Prolonged use of Diphenhydramine (Benadryl) Prolonged use of Chlorphenhydramine (Clor-Trimeton) Cimetadine (Tagamet) Prolonged use of stimulant laxatives such as Bisacodyl (Dulcolax), Senna (cascara sagrada) Mineral oil Medication use Salt substitute Anti-allergy, sleep aid Anti-allergy Antacid Page 5 of 5

Produced by The Kidney Foundation of Canada

Produced by The Kidney Foundation of Canada 31 HELPFUL HINT Become an expert on all the medications you re taking. You should know: Name of medication Strength of medication Dose (how much to take) How often and what time of day to take it What