Medicines that may affect kidney function

Reduce or stop then review

Dosage reduction or cessation of renally excreted medicines is generally required once GFR falls below 60 mL/min/1.73m2.1 It is important to review renally excreted medicines, as well as avoid medicines that can adversely affect kidney function.1

Medicines that may need reduced dose or stopping2

Analgesics codeine
hydromorphone
morphine
oxycodone
tramadol
Blood apixaban
dabigatran
enoxaparin
rivaroxaban
Cardiovascular

atenolol
bisoprolol
digoxin
fenofibrate
atorvastatinA
simvastatinA

Endocrine glibenclamide
glimepiride
gliptins (saxagliptin, sitagliptin, vildagliptin)
metforminB
Gastrointestinal
H2-antagonists
Genitourinary solifenacinC
sildenafil
tadalafil
tolterodineC
vardenafilC
Musculoskeletal allopurinol
bisphosphonates
colchicine
strontium ranelate
teriparatide
Neurological baclofen
gabapentin
galantamine
levetiracetam
memantine
methysergide
paliperidone
pramipexole
pregabalin
topiramate
varenicline
Psychotropic acamprosate
amisulpride
benzodiazepines
bupropion
desvenlafaxine
duloxetine
lithium
reboxetine
venlafaxine
A. Risk of adverse effects increases in patients with kidney disease co-administered medicines that inhibit CYP3A4. A recent study reported increased adverse effects and a low (but avoidable) absolute risk of kidney injury when atorvastatin or simvastatin were taken in combination with clarithromycin or erythromycin.3
B. Maximum daily dose of 2 g for patients with a glomerular filtration rate (GFR) from 60–90 mL/min, and 1 g for patients with a GFR from 30–60 mL/min. Metformin is not recommended for patients with a GFR less than 30 mL/min.4
C. Not available on the PBS/RPBS.

Commonly prescribed medicines and agents that can adversely affect kidney function1

Note: The medicines discussed above do not include antibiotic, antifungal or antiviral medicines, or medicines predominately used in hospital.

References
  1. Kidney Health Australia. Chronic kidney disease (CKD) management in general practice. 2nd edition. 2012. www.kidney.org.au//LinkClick.aspx?fileticket=vfDcA4sEUMs%3d&tabid=635&mid=1584 (accessed 30 May 2013).
  2. Australian Government Department of Veterans' Affairs. Veterans' MATES Topic 30 - Renal impairment. March 2012. www.veteransmates.net.au/VeteransMATES/VeteransMATESServlet?page=site&m=10020 (accessed 18 June 2013).
  3. Patel AM, Shariff S, Bailey DG, et al. Statin toxicity from macrolide antibiotic coprescription: a population-based cohort study. Annals of Internal Medicine 2013;158:869-76. www.ncbi.nlm.nih.gov/pubmed/23778904
  4. Australian Medicines Handbook 2013. Adelaide: Australian Medicines Handbook Pty Ltd, 2013.