DIY Meds

StoryBlocks.com

Over-the-counter medication tips for the renal patient

by Rehal Parmjot, RPh ACPR BScPhm

...just because these are available over the counter, it does not mean they are safe for all to use—especially if you have kidney disease

Over-the-counter (OTC) medications are medications that you can purchase easily at your local pharmacy without a prescription. These include allergy medications, laxatives for constipation or even some herbals and vitamins. However, just because these are available over the counter, it does not mean they are safe for all to use—especially if you have kidney disease. Most medications pass through the kidney and if they are not used correctly, they can hurt your kidneys or interact with your prescription medications to change their effectiveness.

Following are a few tips to help you choose over-the-counter medications wisely. And remember, if ever in doubt, ask your pharmacist.

Pain relievers

There are two categories of pain relievers available as OTCs—acetaminophen (Tylenol®) or NSAIDs (non-steroidal anti-inflammatories) such as ibuprofen (Advil® or Motrin®) or naproxen (Aleve®). In general, kidney patients should avoid NSAIDs since these medications can raise blood

pressure, causing further damage to your kidney. The only exception is Aspirin® 81mg if prescribed by your doctor for heart or stroke protection. Acetaminophen is safe to use at the recommended daily amounts.

Cough and cold preparations

Most cough and cold preparations, such as Buckleys®, Neocitran® or even Tylenol Sinus® contain multiple ingredients, including decongestants such as phenylephrine or pseudoephedrine. These can increase blood pressure or worsen blood glucose levels. In general, it is recommended that kidney patients avoid these remedies and instead, ask their doctor or pharmacist for safer alternatives. Often the pharmacist will recommend other products to specifically target symptoms of a cold such as acetaminophen for fever, single-ingredient allergy medications for sinus or nasal symptoms or throat lozenges for a sore throat. If you have diabetes, look for sugar-free and alcohol-free products.

Allergy medications

Most single-ingredient allergy medications (antihistamines), such as cetirizine (Reactine®) or loratidine (Claritin®) are safe when used by kidney patients to help with sneezing, itching or a runny nose. Often, taking half the recommended daily dose has shown to be effective in managing allergy symptoms while minimizing side effects such as sedation. If nasal congestion persists, saline nasal rinses (Neti Pot®, Hydrasense®) or steroid nasal sprays (Flonase®) can be purchased as OTCs for use. Topical decongestants, such as xylometazoline (Otrivin®) may be used but only for 3-5 days to prevent rebound congestion. Topical decongestants have a lower risk of affecting blood pressure or blood glucose levels than oral decongestants such as those mentioned above.

Laxatives

If you haven’t had a regular bowel movement for a few days, then laxatives such as Lax-a-day®, Restoralax®, Lactulose, Senokot® or Dulcolax® are safe for you to use. Some kidney patients find they have to use these regularly, especially if they are limited in how much fluid they can consume daily. One can modify the dose to help relieve constipation but avoid diarrhea. However, all kidney patients should avoid Fleet® enemas or any magnesium-containing laxatives such as Citro-Mag® or Milk-of-Magnesia. These products contain high levels of phosphate and magnesium, which can quickly build up in kidney patients and cause toxicity.

Heartburn

The occasional episode of heartburn can be treated using calcium carbonate (Tums®), ranitidine (Zantac)® or famotidine (Pepcid AC®) which are all available over the counter. Tums® can also be prescribed as a phosphate binder so check with your doctor if using it frequently for heartburn since it may cause your calcium levels to rise. Kidney patients need to be careful of Maalox®, Diovol® or Gaviscon® brand products as some contain high levels of aluminum or magnesium which can build up and cause toxicity. AlkaSeltzer® should also be avoided since the high sodium content can increase blood pressure. Pepto-Bismol® may increase risk of bleeding and should be avoided. If heartburn persists, talk to your doctor or pharmacist about long-term management, including dietary changes and prescription alternatives.

Questions?

Your pharmacist and members of your kidney health team are the best source of information. Ensure that you read the label, even on over-the-counter medications that you’ve taken before, as ingredients do change from time to time. If you have severe symptoms that last longer than seven days, you should see your doctor. 

Stay connected

Our e-newsletters help you stay connected with what is happening in the kidney community. Receive expert insights and health information, plus discover new ways to get involved by learning what is being done to raise awareness and help reduce the burden of kidney disease. Sign up today at https://kidney.ca/Newsletters or email ontario@kidney.ca.