List of Nephrotoxic Drugs
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| Nephrotoxic Drugs |
Antibiotics
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Vancomycin
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Aminoglycosides (e.g., gentamicin, tobramycin, amikacin)
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Piperacillin-tazobactam (especially when combined with vancomycin)
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Amphotericin B
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Sulfonamides (e.g., trimethoprim-sulfamethoxazole)
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Ciprofloxacin and other fluoroquinolones (less common, but reported)
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)
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Ibuprofen
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Naproxen
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Indomethacin
NSAIDs reduce renal blood flow by inhibiting prostaglandin synthesis, especially in volume-depleted or elderly patients.
ACE Inhibitors / ARBs
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Lisinopril, enalapril, etc. (ACE inhibitors)
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Losartan, valsartan, etc. (ARBs)
Can cause acute kidney injury (AKI), especially in patients with renal artery stenosis or dehydration. Often reversible.
Diuretics
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Furosemide
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Hydrochlorothiazide
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Spironolactone
May lead to volume depletion and prerenal azotemia.
Chemotherapy Agents
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Cisplatin
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Ifosfamide
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Methotrexate (high doses, or with poor clearance)
Immunosuppressants
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Cyclosporine
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Tacrolimus
Can cause vasoconstriction of afferent arterioles and chronic interstitial nephritis.
Contrast Agents
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Iodinated contrast used in CT scans and angiography
Contrast-induced nephropathy (CIN) is a known complication, especially in patients with pre-existing kidney disease.
Other Agents
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Lithium (chronic use → nephrogenic diabetes insipidus or chronic tubulointerstitial nephritis)
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Tenofovir (especially older formulations like TDF)
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Acyclovir (especially IV, due to crystalluria)
Important note:
Always assess renal function (e.g., creatinine, eGFR) before starting potentially nephrotoxic drugs, and adjust doses accordingly. Also, avoid combining multiple nephrotoxins whenever possible.
