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Renal therapeutics: part two

Introduction

Understanding ADME

High-risk medicines

Medicine accumulation

Review

Medication to avoid

Dialysis and transplant patients

module menu icon Medication to avoid

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module menu icon Medication to avoid

Medications customers should avoid taking if they have renal impairment include:

  • Live vaccines – if given to an immunosuppressed patient, there is a real danger that a live vaccine may actually cause the patient to develop the disease they are being immunised against
  • NSAIDs – are inherently nephrotoxic as they destroy the prostacyclin-driven microcirculation throughout the kidneys that feeds each glomerulus and reabsorbs conserved substances from the renal tubules. A transplant patient surviving on one kidney should never be administered NSAIDs as they will inhibit the blood supply throughout the kidney.
  • Macrolides and azole antifungals – both are readily prescribed for chest infections, candida infections, etc. Both are potent CYP3A4 inhibitors and can cause tacrolimus/ciclosporin levels to rise substantially, leading to catastrophic damage to the transplant kidney.

    • Renal therapeutics: part two

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