Kidney Damage from painkillers: What you need to know
Pain is common. Headaches, injuries, arthritis and chronic conditions put many people on pain medicine. For most, a pill eases the day. But some pain medicines can hurt the kidneys if used often or for a long time.
Types of pain and common pain medicinesPain can be classified by how long it lasts and what causes it. Acute pain is short lived. It follows an injury, surgery, or a bad flu. Chronic pain lasts more than three months. It can come from arthritis, nerve damage, cancer, or long-term conditions.
Many pain medicines are available. Some you can buy without a prescription (OTC). Others need a doctor’s script. Common OTC medicines are acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen (Aleve) and topical diclofenac (Voltaren gel).
Prescription pain medicines include stronger NSAIDs, opioid drugs, certain antidepressants and anti-seizure medicines used for nerve pain, and corticosteroids. Some pills mix two or more drugs (for example, aspirin plus acetaminophen) or add caffeine or codeine. Those combination products are the most risky when taken daily for years.
How painkillers can harm the kidneysLong-term use of some painkillers can injure the tiny blood vessels that filter waste in the kidneys. This slow damage is called analgesic nephropathy .
NSAIDs are the main offenders.
They reduce blood flow in the kidney and can cause acute kidney injury (AKI) or worsen chronic kidney disease (CKD). People who take high doses or use NSAIDs every day are at particular risk.
Acetaminophen is generally safer for the kidneys when used at recommended doses. But many products contain acetaminophen plus other drugs. That raises the chance of accidental overdose or combined harms.
Opioids do not directly poison kidney filters in the same way as NSAIDs, but some opioid drugs and their metabolites can build up in people with poor kidney function and cause side effects.
Corticosteroids do not usually cause direct kidney injury, but they can raise blood pressure, cause fluid retention, and increase blood sugar, factors that stress the kidneys over time.
Some painkillers also contain codeine or caffeine. Long-term use of combination pills seems linked to higher rates of kidney damage in several studies. That is why doctors warn against the daily use of multi-ingredient pain medicines for chronic pain.
Who is at higher risk?Not everyone has the same risk. The people most vulnerable include those who already have kidney disease, those over middle age, people with heart disease or liver disease, those taking blood pressure medicines such as ACE inhibitors or ARBs or diuretics, people with autoimmune diseases like lupus, and those who drink heavily or become dehydrated.
Even otherwise healthy people can develop problems if they take large doses for long periods.
Symptoms of kidney damage from painkillers Kidney damage from painkillers can be silent at first. When symptoms appear, they may include fatigue, blood in the urine, more frequent urination, back or flank pain, nausea, swelling in the legs, and confusion.
Doctors use blood tests, urine tests, imaging, and sometimes biopsies to diagnose the problem. The first step in treatment is to stop the offending medicines.
Care may also include hydration, medication adjustments, dietary changes, and pain-management alternatives. The goal is to prevent further damage and treat any existing kidney failure.
Types of pain and common pain medicinesPain can be classified by how long it lasts and what causes it. Acute pain is short lived. It follows an injury, surgery, or a bad flu. Chronic pain lasts more than three months. It can come from arthritis, nerve damage, cancer, or long-term conditions.
Many pain medicines are available. Some you can buy without a prescription (OTC). Others need a doctor’s script. Common OTC medicines are acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), naproxen (Aleve) and topical diclofenac (Voltaren gel).
Prescription pain medicines include stronger NSAIDs, opioid drugs, certain antidepressants and anti-seizure medicines used for nerve pain, and corticosteroids. Some pills mix two or more drugs (for example, aspirin plus acetaminophen) or add caffeine or codeine. Those combination products are the most risky when taken daily for years.
How painkillers can harm the kidneysLong-term use of some painkillers can injure the tiny blood vessels that filter waste in the kidneys. This slow damage is called analgesic nephropathy .
NSAIDs are the main offenders.
They reduce blood flow in the kidney and can cause acute kidney injury (AKI) or worsen chronic kidney disease (CKD). People who take high doses or use NSAIDs every day are at particular risk.
Acetaminophen is generally safer for the kidneys when used at recommended doses. But many products contain acetaminophen plus other drugs. That raises the chance of accidental overdose or combined harms.
Opioids do not directly poison kidney filters in the same way as NSAIDs, but some opioid drugs and their metabolites can build up in people with poor kidney function and cause side effects.
Corticosteroids do not usually cause direct kidney injury, but they can raise blood pressure, cause fluid retention, and increase blood sugar, factors that stress the kidneys over time.
Some painkillers also contain codeine or caffeine. Long-term use of combination pills seems linked to higher rates of kidney damage in several studies. That is why doctors warn against the daily use of multi-ingredient pain medicines for chronic pain.
Who is at higher risk?Not everyone has the same risk. The people most vulnerable include those who already have kidney disease, those over middle age, people with heart disease or liver disease, those taking blood pressure medicines such as ACE inhibitors or ARBs or diuretics, people with autoimmune diseases like lupus, and those who drink heavily or become dehydrated.
Even otherwise healthy people can develop problems if they take large doses for long periods.
Symptoms of kidney damage from painkillers Kidney damage from painkillers can be silent at first. When symptoms appear, they may include fatigue, blood in the urine, more frequent urination, back or flank pain, nausea, swelling in the legs, and confusion.
Doctors use blood tests, urine tests, imaging, and sometimes biopsies to diagnose the problem. The first step in treatment is to stop the offending medicines.
Care may also include hydration, medication adjustments, dietary changes, and pain-management alternatives. The goal is to prevent further damage and treat any existing kidney failure.
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