Kidney Disease and Non-prescription Medications

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.

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People with kidney disease should always be cautious using ASA (Aspirin®) and ibuprofen (Motrin®, Advil®). Small daily doses of ASA used for the prevention of heart attacks or stroke are usually fine. Consult your doctor before using ibuprofen, and before making regular use of ASA.

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

NOTE: Ibuprofen and larger 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 and other non-steroidal anti-inflammatory drugs (or NSAIDs) may limit the effectiveness of blood pressure reducing medications. Before taking ibuprofen, discuss this with your doctor. Acetaminophen does not affect blood glucose readings or blood pressure medication effectiveness.

Try to stay away from decongestants taken orally. They can increase your blood sugar, and can also increase blood pressure. If you have to use a decongestant, use a nasal spray or nasal drops like Otrivin® or Neosynephrine®.

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

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Allergies

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, but some last longer than others, and some may cause unwanted effects like drowsiness. Claritin®, Reactine® and Hismanal® are three of the better-known, longer-acting antihistamines, and do not cause drowsiness.

Like cough syrup, many throat lozenges contain sugar (sucrose), so it’s important for people with diabetes to check the ingredients before use. Cepastat® and Soothease® are both sucrose-free products and may be used safely.

People with kidney disease who experience nausea or vomiting should be careful in assessing the cause. Although both are 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 Gravol® (dimenhydrinate) 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’re going to react. This medication, as well as Benadryl® (diphenhydramine), can also be used to help you get to sleep at night.

For occasional diarrhea, you can safely use Kaopectate®, or Imodium® caplets. Both are low in calories. Stop using them, however, if your symptoms last for more than two days, and 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 Kaopectate® at least two hours apart from other medication.

Most people would think nothing of using iodine, Dettol®, mercurochrome, or medicinal alcohol to cleanse a wound. If you have diabetes, however, all of these products can cause damage to your skin and can increase the risk of infection. Instead, tinse the wound with hydrogen peroxide, and then use Polysporin® cream. If the wound is serious, or if it fails to heal quickly, see your doctor.

If you exercise regularly, include enough fibre in your diet, and drink enough fluid each day, you should be able to avoid constipation completely. Some of the medications prescribed for kidney disease, however, can cause constipation. If such cases, Colace® (docusate sodium) stool softening capsules are very good, although they can take up to four or five days to work. If your needs are more immediate, you may use a stimulant laxative such a Dulcolax® or Senokot®, but never for more than seven days at a stretch. Frequent or prolonged use of these stimulant laxative can be harmful as your body become dependent on them.

People with kidney disease who follow the eating habits recommended by their dietitian should need only a renal vitamin supplement. However, if you believe you need a nutritional supplement, choose one in tablet or capsule form, because many liquid supplements contain sugar and/or alcohol. Before taking a nutritional supplement, consult with a renal dietitian or pharmacist, and avoid taking Vitamin C in doses greater than 500 mg per day, as it will interfere with glucose tests and can cause kidney stones.

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The Common Cold

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 (Otrivin®). If you’ve got a cough and a sore throat, treat the cough with a sugar free, single ingredient product containing dextromethorphan (e.g. Balminil DM sucrose-free ® or Delsym®). As your sore throat will probably improve once you stop coughing, try gargling with salt water, which can be very effective for sore throats. Try to avoid “tiny time pill” products that try to treat everything at once.

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Warts, Corns and Calluses

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, increasing the risk of infection. Don’t use these products without advice from either a podiatrist or a physician. Any product that might damage the skin of your feet should be left to your doctor to prescribe and supervise.

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Heartburn

Excessive stomach acid can cause heartburn, acid reflux and other symptoms. Non-prescription antacids can contain aluminum, magnesium or calcium, all of which should only be used on the advice of your physician. Zantac 75® is one example of a newer acid-suppressing medication that is generally safe for people with kidney disease. If you have heartburn, ask your doctor for advice about what medicine you should use.

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Herbal Medication

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 physician or pharmacist. Herbals are poorly regulated in Canada and can actually contain enough impurities to cause harm.

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Smoking Cessation

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, but you will be more successful if they are 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 physician and pharmacist.

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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.