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Medication

People with chronic kidney disease often take a variety of medications to help manage their disease.

​This information explains how the medications you are taking work and the possible side effects and precautions.  It is not a substitute for talking to your doctor or pharmacist.

What to do when dehydrated

If you are sick

If you have a bad flu or other illness which causes you to vomit or have diarrhea AND you cannot eat or drink normally, you may become dehydrated (dry). Dehydration can affect your kidney function and blood pressure. 

If you are vomiting or have diarrhea or feel very sick, try to drink fluids. It is best to drink fluids that do not have caffeine. If you are so sick that you cannot drink your normal amount of fluids, there are some medications that your doctor might suggest you not take until you are able to start drinking fluids again. 

Ask your doctor for a plan about what to do about your medications if you get sick. 

Medication changes

Print off the patient teaching sheet Medication changes when you are sick and take to your next doctor's appointment.

Related conditions & treatment

Here are information sheets on common drugs that may be used to treat conditions that patients with kidney disease may experience.
 
 

Iron Bivalent, Oral Preparations:

Vitamin B-12:

 

  • desferoxamine
 
Dopamine Antagonists
Histamine (H2) Receptor Antagonist

Osmotic Laxatives

Stimulate Laxatives

Stool Softeners

Upper Gastrointestinal Tract Agents

Antimitotics

Corticosteroids
 

Topical Antibacterials

 

Phosphate Binders

Calcium Supplements

Vitamin D3

  • cholecalciferol (pediatrics only)

 

 
Leg Cramps

Neuropathic Pain

Restless Leg Syndrome

Anaesthetics

 
Note: All formulary medications are available to BCPRA-registered pediatric patients (pre-dialysis and dialysis patients under the age of 18). Any compounded formulations of formulary medication or commercially available liquid forms of medication will also be funded for pediatric patients.
 

Antihistamines

Topical Cream
  • 10% uremol in glaxal base
 

Symbols used

Restrictions apply to some drugs. Here's what the symbols beside the drug mean.

^ Injectable medication

* Needs approval through PROMIS

** Restricted to patients with an intractable cough to ACE inhibitors (as per pharmacare)

*** Application for sevelamer required to be completed and send to BC Renal Agency (not for prior approval but for audit purposes)

**** Cinacalcet (Sensipar) is very restricted and approval will be granted on a case-by-case basis. Nephrologists may contact the BCPRA office.

***** Restricted for adult patients experiencing hemodialysis needling pain as per guideline. Not restricted for pediatric patients.

****** Restricted to PD bowel prep

# Approved as prophylaxis against fungal peritonitis in PD patients only at a dose of 200 mg orally every two days to a maximum duration of concomitant antibiotic treatment + one week. Practitioners should be alert for drug interactions with fluconazole.


Non-Prescription Medicines

In addition to their prescribed medications, many people with kidney disease use non-prescription medications from time to time.

Before using any non-prescription medicine, however, it is important to know if that product might interact with your prescription medication, and what effect it might have on your medical condition.

Always read the label of non-prescription drugs and use only as directed. If you don’t understand the directions or are unsure about whether the medicine is right for you, ask a pharmacist and tell them that you have kidney disease.

The following information will help you to choose among some products used for treating common minor ailments. If you don’t find the information you need below, or if you have any questions, talk to your doctor and/or a pharmacist. 

Also see:

Allergy symptoms vary from person to person and can change from season to season. Antihistamines with a single ingredient are the most common form of allergy medication. All non-prescription allergy products are similar, some last longer than others, and some may cause unwanted effects like drowsiness. Half the usual dose of loratadine (Claritin), desloratadine (Aerius) or citirizine (Reactine) are safe to take and these medications will not make you feel drowsy. Chlorpheniramine (Chlor-Tripolon) or diphenhydramine (Benadryl) are safe to take but they may make you feel drowsy.

 

For a common cold it's always best to treat your main symptom and use medications with as few ingredients as possible. If your problem is a stuffed-up nose, use a nasal decongestant such as xylometrazoline (Otrivin®). If you've got a dry cough and a sore throat, treat the cough with a sugar-free, single ingredient product containing dextromethorphan or DM (e.g. Benylin DM® or Robitussin DM syrup®). As your sore throat will probably improve once you stop coughing, try gargling with salt water. This can be very effective. Avoid "tiny time pill" products that try to treat everything at once.

 

Exercise regularly, include enough fibre in your diet and drink enough fluid each day to avoid constipation completely. Some of the medications prescribed for kidney disease can cause constipation. In such cases, docusate sodium (Colace®) stool softening capsules are very good. Other options include lactulose syrup and polyethylene glycol 3350 powder (Lax-A-Day® or Restoralax®).


Avoid laxatives that have magnesium or phosphate (Milk of Magnesia®, Fleet Enema or Oral Fleet). It is hard for your kidneys to get rid of extra magnesium or phosphate and a build-up may cause unwanted effects.

 

If you have a productive cough, use guaifenisin (Robitussin® syrup). For a dry cough, try dextromethorphan or DM (Benylin DM® or Robitussin DM® syrup). Avoid oral decongestants such as pseudophedrine (Sudafed®) and products with multiple ingredients (e.g. Robitussin Cough & Cold®, Benylin Cough & Cold®, Benylin Cough & Chest Congestion® syrup).


As many cough syrups contain sugar (sucrose), if you have diabetes, check the ingredients before using. Make sure to use a sugar-free cough syrup.


Cough medications are not safe for children under 6 years old.

 

For occasional diarrhea, you can safely use kaolin-pectin (Kaopectate®) or loperamide (Imodium®) caplets. Both are low in calories. Stop using them if your symptoms last for more than two days. Don't use them at all if you have a fever as well as diarrhea. If you have persistent diarrhea or a fever associated with diarrhea see your doctor. Be sure to take kaolin-pectin (Kaopectate®) at least two hours apart from other medication. Avoid taking Pepto-Bismol® as it contains salicylic acid that may harm your kidneys.

 

For most people with kidney disease, acetaminophen (Tylenol®) is safe and effective for the treatment of occasional fever and minor aches and pains.

People with kidney disease should always be cautious using ASA (Aspirin® orEntrophen®), naproxen (Aleve®) or ibuprofen (Motrin®, Advil®). If you take these medications, never take more than 325 mg ASA per day and preferably avoid ibuprofen and naproxen. Larger doses may increase your blood pressure and harm your kidneys.


Small daily doses of ASA (baby Aspirin®) used for the prevention of heart attacks or stroke are usually fine. Consult your doctor before making regular use of ASA, naproxen or ibuprofen.


Note

  • Ibuprofen, naproxen and higher doses of ASA may interfere with blood glucose measurements causing the glucose reading to appear lower than it really is. If you monitor your blood glucose, remember to take that into account when using these drugs.
  • Ibuprofen, naproxen, ASA and other non-steroidal anti-inflammatory drugs (or NSAIDs) may limit the effectiveness of blood pressure reducing medications. If you are on blood pressure reducing medications, discuss the use of NSAIDS with your doctor. Acetaminophen does not affect blood glucose readings or blood pressure medication effectiveness.
 

Excessive stomach acid can cause heartburn, acid reflux and other symptoms. Non-prescription antacids can contain aluminum, magnesium (e.g. Maalox®, Mylanta®,Gaviscon®) or sodium (Alka-Seltzer®), all of which should only be used on the advice of your doctor. Your kidneys may not be able to get rid of the extra aluminum, magnesium or sodium and a build-up may cause unwanted effects.


One or two Tums (calcium carbonate), ranitidine (Zantac 75®) or famotidine (Pepcid AC®) can be taken sometimes. If you need something regularly, talk to your doctor or pharmacist.

 

There are many herbal medications on the market. However, most have not undergone rigorous scientific testing to prove their claims. Many of these medications are safe to take in recommended doses. A few, however, can increase blood pressure, leading to possible complications for people with kidney disease. Never start an herbal medication before consulting your renal doctor or pharmacist. Herbals are poorly regulated in Canada and can actually contain enough impurities to cause harm.

 

Try to stay away from decongestants taken by mouth (e.g. Sudafed® or phenylephrine which is found in many cough and cold products such as Dimetapp®,Neocitran® and Contact-C®). They can increase your blood sugar, and can also increase your blood pressure making your kidneys work too hard. If you have to use a decongestant, use a nasal spray or nasal drops such as xylometrazoline (Otrivin®).

You should be aware that these nasal sprays are habit-forming. If you use them more than five days at a time the blood vessels in your nose can become dependent on the spray.


 

People with kidney disease who experience nausea or vomiting should be careful in assessing the cause. Although both can be symptoms of minor disorders, they can also indicate more serious illnesses. By using non-prescription medication to treat nausea and vomiting you could delay the diagnosis and treatment of a serious medical condition. If you see blood in your vomit, or if your nausea is accompanied by abdominal pain and/or fever see your doctor immediately.


If you are certain that your nausea and vomiting are not due to anything serious you may wish to use dimenhydrinate (Gravol®) to treat your symptoms. It works well for a range of different causes including motion sickness. For motion sickness you should take it at least half an hour before you start travelling. Dimenhydrinate may cause drowsiness so avoid driving when taking this drug until you know how you react. This medication can also be used to help you get to sleep at night.

 

 

People with kidney disease who follow the eating habits recommended by their dietitian may not need any supplements. However, if you believe you need a nutritional supplement choose one in tablet or capsule form as many liquid supplements contain sugar and/or alcohol. Before taking a nutritional supplement, consult with a renal dietitian or pharmacist. In general, avoid taking vitamin B or vitamin C in doses greater than 500 mg per day and avoid taking vitamin A. These will interfere with glucose tests and can cause kidney stones.

 

There are few things you can do that are more effective at improving health than quitting smoking. However, quitting can be difficult and can be helped by using a strategy. Pick a start date and muster the support of people close to you. There are also medications to help you quit smoking. You will be more successful if this is only part of an overall plan. Common medications include nicotine in the form of a gum, a patch or an inhaler. To improve your chances for success, discuss your plan to quit with your doctor, pharmacist or social worker.

 

For most people with kidney disease, acetaminophen (Tylenol®) is safe and effective for the treatment of occasional sore throat.


Like cough syrup, many throat lozenges contain sugar (sucrose). It is important for people with diabetes to check the ingredients before use. Ricola Sugar Free® andBentasil Sugar-free® are both sucrose-free products and may be used safely. Halls® or Bradosol® sugar-free lozenges are also safe.

 

If you are going for a special x-ray such as a CT scan or angiogram, talk with your kidney doctor or nurse. They will suggest ways to help protect your kidneys. Some contrast dyes can damage the kidneys.

 

For people with diabetes, foot care is particularly important, including regular foot hygiene. Be especially careful with non-prescription products that treat warts, corns and calluses as they contain caustic substances which break down the integrity of the skin and increase the risk of infection. Don't use these products without advice from either a podiatrist or doctor. Any product that might damage the skin of your feet should be left to your doctor to prescribe and supervise.

 

Remember

People with kidney disease need to be more careful about all the choices they make including their choices of over-the-counter, non-prescription medicines.

  • Be careful about the medications you buy.
  • Buy single-ingredient medications whenever possible.
  • Avoid liquid medications as most contain sugar and/or alcohol or other calorie-containing substances.
  • Don't continue to use a product just because you've always used it in the past. It may no longer be safe for you.
  • If you have questions, ask a pharmacist for advice about the products best suited to your special needs.


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