Nephrotoxic drugs
Nephrotoxic drugs cause kidney injury through ↓ renal perfusion, tubular cell toxicity, or interstitial inflammation.
Always check the BNF link here for full prescribing information.
🩺 Common Nephrotoxic Drugs (High-Yield for OSCE/Exams)
- 💊 NSAIDs (Ibuprofen, Naproxen, Indomethacin)
– Inhibit prostaglandins → ↓ renal blood flow → AKI.
– ⚠️ Risk ↑ in CKD, elderly, dehydrated.
– Part of the “triple whammy” with ACEi + diuretics.
- 🧫 Aminoglycosides (Gentamicin, Tobramycin, Amikacin)
– Direct tubular toxicity → acute tubular necrosis (ATN).
– Must monitor drug levels + renal function.
- ❤️ ACE Inhibitors & ARBs (Lisinopril, Enalapril, Losartan, Valsartan)
– Dilate efferent arteriole → ↓ GFR, esp. in hypovolaemia or renal artery stenosis.
– Monitor U&Es + potassium within 1–2 weeks of initiation.
- 💧 Diuretics (Furosemide, Thiazides)
– Volume depletion + electrolyte imbalance.
– Avoid over-diuresis; monitor U&Es.
- 🩻 Iodinated Contrast Agents (CT scans, angiography)
– Contrast-induced nephropathy (CIN).
– Prevent with hydration + lowest dose contrast.
– Follow NICE AKI guidance for high-risk patients.
📚 Specialist / Less Common Nephrotoxic Drugs
- 🛡️ Calcineurin Inhibitors (Ciclosporin, Tacrolimus)
– Chronic interstitial nephritis, progressive scarring.
– Requires drug-level monitoring.
- 🦠 Amphotericin B (conventional)
– Tubular cell damage → hypokalaemia, hypomagnesaemia.
– Use liposomal formulations if possible.
- 🎗️ Chemotherapy Agents (Cisplatin, Methotrexate, Ifosfamide)
– Direct tubular toxicity → AKI/CKD.
– Prevent with IV hydration ± protective agents (e.g. amifostine with cisplatin, folinic acid with methotrexate).
💡 Teaching Pearl
✅ Always check renal function (U&Es, eGFR) before starting these drugs.
✅ Monitor closely during treatment, especially in CKD, elderly, or dehydrated patients.
✅ Be alert to the “triple whammy” (NSAID + ACEi/ARB + diuretic) → very high AKI risk.
