Your kidneys do a lot more than filter waste. They help regulate blood pressure, balance fluids and minerals, support red blood cell production, and keep your bones healthy. Because of this wide-ranging responsibility, they’re also highly vulnerable to certain medications. Even drugs meant to help you can become harmful to your kidneys under the right conditions. Knowing which medications carry risks—and how those risks increase—can help you take better care of your kidney health.*

Medications That Can Be Risky Under Certain Conditions

Some drugs, such as ACE inhibitors and ARBs, are not only common but are often prescribed to help people with kidney disease. These medications support heart and blood pressure health and typically end in “-pril” or “-sartan.” On their own, they’re usually safe, but your risk of acute kidney injury increases significantly if you’re also:

• Dehydrated, 
• Taking non-steroidal anti-inflammatory drugs (NSAIDs), or 
• Using strong diuretics. 

Acute kidney injury can develop rapidly, impairing your kidneys’ ability to filter waste.

Diuretics, often called water pills, are also widely used to treat high blood pressure and fluid retention. Loop diuretics like furosemide carry a greater risk of kidney damage than thiazide diuretics. 

The risk is even higher if you have additional conditions such as heart failure or pneumonia. While these medications can be essential, they reduce blood flow to the kidneys, which may cause lasting harm.

NSAIDs—including ibuprofen, naproxen, and aspirin—are frequently used to manage pain and inflammation. When taken daily or combined with drugs like ACE inhibitors or diuretics, they can contribute to chronic kidney disease and other complications. Even over-the-counter use should be discussed with a healthcare provider if you’re at risk.

Drugs Known to Cause Direct Kidney Damage

Other medications carry a more direct threat to your kidneys, particularly when used over time or at high doses. Several types of antibiotics fall into this category. Some, like gentamicin and ciprofloxacin, can damage filtering structures or block kidney tubules. In some cases, antibiotics may even trigger allergic reactions that inflame the kidneys, a condition known as interstitial nephritis.

Proton pump inhibitors (PPIs), such as omeprazole and esomeprazole, are often taken for acid reflux but are associated with both acute and chronic kidney problems. Lithium, prescribed for bipolar disorder, is also linked to kidney injury and specific conditions like nephrogenic diabetes insipidus, which affects your body’s ability to manage fluid balance.

Medications for HIV, such as tenofovir disoproxil fumarate, can be nephrotoxic as well, although newer formulations like tenofovir alafenamide may carry lower risks. Calcineurin inhibitors, used after organ transplants, can restrict blood flow to the kidneys and lead to long-term damage.

Minimizing Risk and Monitoring Symptoms

To protect your kidneys, make sure all your healthcare providers are aware of every medication, supplement, and over-the-counter drug you use. Using a single pharmacy and keeping an updated medication list can help identify potential risks early. 

Dehydration increases the risk of kidney complications, especially if you’re ill, so it’s essential to stay hydrated and follow medical advice carefully during illnesses.

Watch for warning signs such as:

• Swelling in your legs, 
• Changes in urination, 
• Fatigue, or 
• Back pain. 

Even in the absence of symptoms, regular monitoring of kidney function is essential if you’re on medications known to carry risks. Speak with your doctor or pharmacist about possible drug interactions before taking any new medications, and let your doctor know if you experience any new symptoms.

Being informed about the medications you take—and how they may impact your kidneys—can empower you to make safer, healthier choices.

*Berger, K. (2025, March 27). 8 Drugs That Can Cause Kidney Damage. Verywell Health. https://www.verywellhealth.com/top-drugs-that-cause-kidney-damage-11697766 

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