Show Notes

Tune into this episode where Dallas Nephrologist Dr. Daniel Richey talks about how some medications can keep your kidneys from working the way they should. Dr. Richey covers the most common over-the-counter (OTC) medications that are approved and not approved for patients diagnosed with kidney disease. Learn how to choose the right medications, and which ones to avoid.

What OTC Medications Should Kidney Patients Avoid 

Dr. Richey explains that the most important class of medications that patients with kidney disease should know about are non-steroidal anti-inflammatory drugs (NSAIDs). These include brand names like Ibuprofen, Aleve, Motrin and Naproxen. 

Kidney Damage From OTC Drugs – NSAIDs

NSAIDs can be very dangerous for patients who have kidney disease to use on a daily basis. Dr. Richey tells his patients that it’s OK to use these kinds of over-the-counter medications if they have an acute injury or need to reduce a fever. 

While NSAIDs can sometimes be used sparingly, taking them on an ongoing basis can cause severe damage to the kidneys.

Dr. Richey emphasizes that he’s seen many patients experience significant kidney function decline as a result of improper NSAID use. He recommends talking to your doctor if you’re not sure if you’re taking an NSAID.

Medications, Supplements That Cause High Blood Pressure 

NSAIDs can cause fluid retention, electrolyte disturbances in blood work and can raise your blood pressure. 

Other supplements, medications and herbs that can cause high blood pressure include:

  • Pseudoephedrine, which is commonly used for colds to relieve sinus stuffiness
  • Popular over-the-counter weight loss supplements
  • Licorice extract and licorice
  • Some preparations of Chinese herbs 

Additionally, for many kidney disease patients, Vitamin C can be safe, Dr. Richey says. But patients with a history of kidney stones need to be careful with Vitamin C.

What Over-the-Counter (OTC) Medications Can Kidney Patients Take For Pain? 

When it comes to selecting over-the-counter drugs for joint pain and fever, Dr. Richey says your choices are pretty straightforward – Tylenol (or acetaminophen). He says that these medications are completely safe for your kidneys.

Keep Your Kidney Doctor in the Loop 

Kidney patients often see several different doctors who prescribe them medications, so their lists change on a regular basis. Dr. Richey recommends that patients keep a list of their medications so they can bring it to their doctor appointments. When your kidney doctors know exactly what medications you’re taking, they can provide you with the best overall care.


Tiffany Archibald  00:01

Let’s talk about kidneys takes a deep dive into the chronic kidney disease patient journey. We’re here to inspire meaningful conversations and to help people living with CKD gain a full understanding of their disease. Join us to learn about the different over the counter medications and how to choose the right medications for your symptoms if you have kidney disease. Welcome, everyone to today’s topic. Our nephrologists that we have that as our specialists is Dr. Richey, and we will be discussing over the counter prescribed and herbal supplements. Welcome Dr. Richey, how are you today?

Dr. Richey  00:41

I’m good. Thank you for having me.

Tiffany Archibald  00:43

Good. Good. So let’s jump right into it. What over the counter medications do patients need to be aware of if they have chronic kidney disease?

Dr. Richey  00:51

So as you know, there’s a lot of different over the counter medications, but we try to be very specific with our patients as far as what they need to avoid. So I would say the first and by far the most important class of medications we want to tell our patients about are the non steroidal anti inflammatory drugs. We call these the NSAIDs.

Tiffany Archibald  01:15

Okay. And so can you give me some examples of some NSAIDs?

Dr. Richey  01:19

Yeah, so the most common ones, we come across ibuprofen, Aleve, Motrin, naproxen. These are all the over the counter versions, even aspirin and BC powder do fit within this category. And then there’s some prescription medications, like Celecoxib or Meloxicam that also fit in this category.

Tiffany Archibald  01:40

Okay, so if a patient is having different ailments, are they able to use them all?

Dr. Richey  01:45

They can use them sparingly. Alright. The issue is daily usage for our patients. So using these medications on a daily basis can be very dangerous for patients who have kidney disease.

Tiffany Archibald  02:00

Okay, and so please can you be specific with sparingly. I know you said not daily, but say that there’s a injury or just that aching knee pain, how often what sparingly be.

Dr. Richey  02:14

So what I tell our patients if they have some sort of acute injury, so they hurt their shoulder or their knee and they need something for a couple of days for the pain, it’s pretty safe in that situation. Same thing, if they’re using it for as a fever reducer, when they’re ill, that’s okay. But if someone has chronic osteoarthritis, or has a chronic pain, but they intend to use this medication on an ongoing basis, those are the patients we really have to warn that, you know, you could really do some damage to your kidney. So what I would tell people is, if you’re going to use it for more than two or three days in a row, you probably want to talk to your either your nephrologist or your primary care physician to see if there’s an alternative medication that you should use.

Tiffany Archibald  03:00

Okay. And then can you discuss some of the problems that these medications can cause by taking them too often?

Dr. Richey  03:07

Yeah, NSAIDs can do a lot of different things to our patients and their kidneys. So, you know, you can get what we call an acute kidney injury, meaning your kidney function can go from whatever your normal is to use a more abnormal number over the course of even a couple of days, you know, that’s a more extreme example. But long term damage is the main problem. It can cause fluid retention, some electrolyte disturbances on their blood work, and it can raise your blood pressure, too. So that’s why long term usage, you know, really can be detrimental to our patients.

Tiffany Archibald  03:49

So Dr. Richey, we talked about elevated blood pressure when taking NSAIDs. Are there any other over the counter medications that patients should be aware of that elevate the blood pressure as well?

Dr. Richey  04:00

Yeah, absolutely. You know, over the counter medications such as pseudoephedrine, which is commonly used for its old remedy for patients that have sinus stuffiness. It’s a stimulant medication, and so it raises blood pressure. And along the same lines, there are some over the counter weight loss supplements that are somewhat popular, and they work the same way. They’re stimulants. And, you know, they might induce a little bit of weight loss, but they also raise patient’s blood pressure. So those are very important to know about. And then a lesser known problem is licorice extract, and for that matter, actual licorice intake, and this is different than taking in eating Twizzlers, or something like that. But pure licorice extract definitely raises blood pressure. And so some people use that as a flavoring for coffee or tea, things like that. So I need to be aware that it can definitely affect their blood pressure.

Tiffany Archibald  04:57

Okay. And are you able to give us why? Like two examples of some of the weight loss supplements that you see people commonly taken that may stick out so that if they hear this, this talk, they can say, Dr. Richey said, you know, this one will raise my blood pressure or that one.

Dr. Richey  05:14

Yeah. I don’t know the brand names, because there’s quite a few of them. I couldn’t tell you that. But if you look on the back labels, this, what’s the ingredient that you would most likely see is something called Synephrine? Yeah. And so if you see that, then just know that that’s a stimulant medication, and that could raise your blood pressure.

Tiffany Archibald  05:14

Okay. As you mentioned before, any medications that you’re taking should be considered, or approved, first, by your nephrologist. Now, one thing is it important to have patient bring all of the medications, all the supplements that they’re taking, including the prescribed ones to their appointments with you, would that be beneficial?

Dr. Richey  05:57

Absolutely, we recommend patients bring their list. You know, a lot of times, our patients have several different doctors, they’re getting prescriptions from different people, they, even the over the counter medications they take, they need to bring them in, because, you know, their lists change on a regular basis. And so it’s really, really helpful for us, when patients bring their medications in. That way we know exactly what they’re taking and how much of what they’re taking. So, yes, we do recommend people bring their prescriptions into their appointments.

Tiffany Archibald  06:30

And then just a quick side note, I know that if you are a Dallas Nephrology patient, you do have access to online an online account, which is called Follow My Health. And in that app, you’re able to add medications, you’re able to communicate with your nephrologist through that so patients can put that information in there as well as bring them to the appointment.

Dr. Richey  06:57

That’s true. And several times a day, I get messages directly from my patients asking me Hey, can I take this? And that’s been very helpful, because if it’s okay, I give them a thumbs up. If it’s not I explain why No, please don’t take that. Here’s why. So yes, if you have that option, especially for our patients, I highly recommend you take advantage of that.

Tiffany Archibald  07:18

Yes, exactly. That app is awesome. And so can you give me some examples of alternative medications that can be used.

Dr. Richey  07:26

So if we’re talking about over the counter drugs, it’s pretty straightforward. Tylenol, or acetaminophen is pretty much the only medication that patients can use for the same indications. So whether that’s joint pain, fever, you’re pretty much stuck with Tylenol for those indications, and it’s completely safe for your kidneys.

Tiffany Archibald  07:49

Okay. And so now I know that we are in the times of holistic health, and everybody wants to do the natural way and the homeopathic solution to things. Can you talk about herbal supplements?

Dr. Richey  08:03

Yeah, there’s a lot of different supplements out there. And I would, I’ll tell you, I’ll give you some of the more concerning ones that we as nephrologist care about. Chinese herbs, you know, which again, there’s there’s a lot of them. Certain preparations of Chinese herbs can be very damaging to the patient’s kidneys. And, you know, that’s not on the bottle, by the way when you get it. So what I tell people is, I don’t expect them to understand which herbs are detrimental, but for Chinese herbs, talk to your nephrologist, tell them what you want to take why you want to take them, let them you know, look that up for you. If they don’t know exactly what it is. That’s probably the most concerning one. There’s also herbal preparations out of India that have some concerning ingredients in them. So I think in both of those situations, rather than give patients exact names of the supplements, just know you need to touch base with your nephrologist before you take them. And beyond that. The other thing I tell patients is just be wary that all these herbal supplements are readily available. And a lot of times you’d actually don’t know what’s in it. Just because it says one thing on the bottle, especially outside of this country. Some of these medications have other ingredients that you’re not aware of. So, you know, I always just tell them, be careful, but make sure you tell us what you’re taking. Okay,

Tiffany Archibald  09:35

That’s extremely important to know because I know patients kind of, you know, the internet is the information superhighway. And sometimes they can kind of steer them in the wrong direction. So I’m glad that you clarify that and stress the importance of talking to your nephrologist. So what about vitamin supplements, you know, we can go through the alphabet A through D A through E Can you touch on those?

Dr. Richey  10:00

Typically we use vitamin D very commonly. You know, Vitamin D is used for a lot of different indications. But for our patients, bone health is very important because chronic kidney disease can lead to bone loss. So vitamin D is generally speaking very safe, we don’t have a lot of problems with that. As far as the other vitamins A, B, E, we don’t have a lot of issues with those. We don’t use them on a regular basis, but they’re safe. Vitamin C also is generally safe. But if you are a patient who has a history of kidney stones, you have to be very careful with long term vitamin C use. So kidney stones, we usually restrict that, but for the rest of our kidney disease patients, it’s relatively safe.

Tiffany Archibald  10:49

And then one of our final questions caffeine, I know that we all need that extra boost. So can you talk about caffeine and how that affects the kidneys?

Dr. Richey  11:01

Sure, yeah, I get this question, at least once a day. Caffeine is very safe for the kidneys and doesn’t cause any damage. There’s always a concern about patients blood pressure with caffeine intake. And while it is true that caffeine can raise blood pressure, it’s not usually clinically significant. So if you’re used to having one or two cups of coffee, I don’t take those away from my patients. Now, if you’re drinking 10 cups a day we were going to have a discussion about that. But otherwise, I consider caffeine to be pretty safe.

Tiffany Archibald  11:33

Okay. You say that it can raise the blood pressure. So if a patient is, you know, one of those that are have to take their blood pressure several times a day, how much of a jump should a patient see in that?

Dr. Richey  11:47

If they’re used to consuming caffeine, you might see four or five points on their blood pressure number increase after drinking or taking caffeine, but it wouldn’t be much more than that.

Tiffany Archibald  12:01

Okay. All right. So we covered a lot today, we talked about the NSAIDs, and making sure that you contact the nephrologist. If you have questions about herbal supplements, and the just the natural vitamins that people can take, is there any touch points that you want to kind of double back on that we may have kind of went over?

Dr. Richey  12:23

I really want to emphasize the NSAIDs. All right, we have a lot of patients whose kidneys have declined significantly taking these medicines. So again, the take home from this is watch your NSAID usage. If you’re not sure if you’re taking an NSAID again, call your doctor.

Tiffany Archibald  12:44

All right. All right. Well, thank you, Doctor Richey, thank you so much for being with us today. You provide a wealth of information on something that is important because patients sometimes just you know they have a headache, they run to the drugstore. So referring back to your nephrologist, and running everything that you take through them is important. Absolutely. All right. Thank you. Thank you. Thanks for tuning in today learn more about Dallas nephrology associates at And if you found the information valuable be sure to share with those who are impacted by chronic kidney disease.


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