Painkillers in kidney disease

Which painkillers can be used in kidney patients? Which painkillers are safe in kidney patients? NSAIDs in kidney disease. Opioid in kidney disease.


One of the most prevalent and bothersome symptoms of chronic renal disease is pain. 

When picking a pain reliever (analgesic), keep in mind that some varieties should not be used by persons with renal issues or should only be used under the supervision of a doctor.


A stepwise strategy is utilized when a pain reliever is given for you for either acute (short-term) or chronic (long-term) pain. Therefore, the weakest painkiller in the painkiller ladder is given first. If you are still in pain, you will be given a more potent pain reliever. Your discomfort, as well as any adverse effects, will be thoroughly monitored.


Patients with renal insufficiency and end-stage renal disease (ESRD) frequently experience pain, which can substantially impact their quality of life. You should avoid many analgesics if your renal function is impaired because they diminish blood flow to the kidney. Long-term usage at greater levels may also destroy healthy kidneys. 

It’s crucial to remember that, while beneficial, these medications are not without danger, and they should be used with caution. 


What are analgesics?


Analgesics are pain relievers, fever reducers and also help in reducing inflammation. Aspirin, acetaminophen, ibuprofen, Ketoprofen, and naproxen sodium are examples of over-the-counter painkillers.


Types of painkillers:


The following are the most common forms of pain relievers:


  • Paracetamol
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
  •  Weak opioids, such as codeine, dihydrocodeine, and tramadol
  • Strong opioids, such as morphine, oxycodone, and alfentanil 
  • Others, such as amitriptyline and gabapentin


The sort of pain reliever given is determined by the severity of your pain and discomfort and its source.

  • Paracetamol: 500mg-1g every four to six hours is the typical dose, with a maximum of eight pills in 24 hours. Only take 500mg every 6-8 hours if you weigh less than 50kg or have a liver condition. If paracetamol does not relieve your pain, you may need to take another pain reliever. Long-term use of this medication may cause liver damage.

  • NSAIDs: These medications, as tablets, creams, or gels, are best avoided since they might worsen your renal function. As a result, you should only use NSAIDs if your renal specialist has recommended them. NSAIDs are often taken twice or three times a day, depending on the medicine and formulation. Indigestion, stomach ulcers, gastrointestinal bleeding, rash, worsened asthma, acute renal damage, elevated blood pressure, and fluid retention are possible side effects (oedema).

  • Weak Opioids: These drugs are typically given every four to six hours, with a maximum of six doses in 24 hours. People with renal illness frequently only require very modest quantities of opioids, and even with a small amount, they often have significant adverse effects. Constipation, feeling/being nauseous, and tiredness are all possible side effects.

  • Strong Opioids: In most cases, morphine and oxycodone are given every four to six hours. Depending on the drug, they are also available as slow release’ preparations or skin patches that can be administered less regularly. People with renal illness frequently only require extremely modest doses of opioids, and even with a small amount, they often have significant adverse effects. Constipation, feeling/being nauseous, and tiredness are all possible side effects. Constipation can be relieved with laxatives, but only after consulting with your doctor or pharmacist.

  • Other painkillers: Gabapentin, amitriptyline, etc., are frequently used to treat neuropathic (nervous system) pain. They’re typically taken once or twice a day. People with renal illness generally only require extremely tiny dosages of these medications, and even with a small amount, they often have more significant adverse effects. Drowsiness, anxiety, and dizziness are all possible side effects.


Which pain relievers are safe if I have renal problems?


If you have renal difficulties, using paracetamol in regular amounts is safe. 

Opioids should be taken with caution, starting with tiny doses and gradually increasing the amount, if necessary, all under physician supervision.


Is it safe to use aspirin frequently?


  • When taken as advised, regular aspirin usage does not appear to raise the risk of renal disease in those with normal kidney function. However, consuming excessive amounts (often more than six or eight pills per day) might decrease kidney function momentarily and potentially permanently. 


  • Aspirin might increase the risk of bleeding in persons with renal disease. People with impaired kidney function and those with other health issues such as liver or heart disease should not use aspirin without first consulting their doctor.


Are analgesics harmful to the kidneys?


  • Consult your doctor to ensure that you can safely use these medications, especially if you have a renal illness. 
  • Some of these medications, such as ibuprofen, naproxen, and higher-dose aspirin, can develop chronic kidney disease known as chronic interstitial nephritis if used excessively or for an extended period. 
  • Over-the-counter analgesics come with warning labels not to use for more than l0 days for the pain and more than three days for fever. 
  • If you suffer pain and fever for an extended period, you should seek medical attention. The doctor can check for any potential medical issues and advise you on which drugs to take.


What are nonsteroidal anti-inflammatory drugs (NSAIDs)? 

Is it safe to take them?


The use of nonsteroidal anti-inflammatory drugs (NSAIDs) can assist in reducing pain and inflammation. Some NSAIDs are available without a prescription. 

They include ibuprofen, naproxen sodium, and Ketoprofen of various brands.


But you should not use an NSAID if you have high blood pressure, heart failure, or renal illness or use it only under a specialist’s supervision. It is because:


  • Blood pressure is harmed by nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs have been linked to increased blood pressure. They can also make your high blood pressure worse if you already have it. You’re more likely to have a heart attack or a stroke if you do this.
  • The use of NSAIDs is harmful to your heart and kidneys: Long-term usage of NSAIDs might cause your body to retain fluid. It can exacerbate heart failure symptoms, including shortness of breath, swelling ankles, and a fast or irregular pulse.
  • NSAIDs may wreak havoc on your kidneys and induce fluid retention. They may be okay to use if you’re on dialysis and don’t make any urine, but they can cause stomach and gut bleeding and shouldn’t be taken for lengthy periods or if you’ve had ulcers before.


What can be done to keep the kidneys healthy?


  • Over-the-counter pain medicines should not be used for more than ten days for pain or three days for fever. 
  • You should consult your doctor if you experience discomfort or a fever for more than a few days.
  • Avoid using analgesics that include a combination of painkilling chemicals, such as aspirin, acetaminophen, and caffeine in one tablet, for an extended period.
  • Increase your water intake to six to eight glasses each day if you’re using analgesics.
  • Avoid consuming alcohol if you are taking analgesics.
  • If you have a renal illness, talk to your doctor before using an analgesic, especially nonsteroidal anti-inflammatory drugs (NSAIDs) or high-dose aspirin.
  • If you have heart disease, high blood pressure, renal disease, or liver disease, or if you take diuretic drugs or are over 65 years old, use NSAIDs under your doctor’s supervision.
  • Make sure your doctor is aware of all medications you’re taking, including over-the-counter ones.
  • Before using any over-the-counter analgesics, make sure to read the warning label.

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