Taking Medications

If your doctor has told you that you have a kidney problem, he or she may prescribe medicines for you. Or, you may be taking medicine for other health problems.

Medicines are used to treat disease and to help reduce symptoms so you feel better. Some may do just one of these things, others may do both. Remember, over-the-counter (OTC) drugs are medicine, too. Some over-the-counter medicines are not safe for people who have kidney disease.

Before you take any new medicine, even a vitamin, ask your doctor if it is safe for you.

Medicines work best if you take them the right way—the way your doctor prescribed them. If the cost of your medicines is a problem, talk to your care team.

Your Kidneys & Liver Remove Medicine Wastes from Your Blood

When your body uses medicines, they are broken down into wastes. These wastes must be removed from your blood, or they could build up to unsafe levels. Your liver removes some medicine wastes. Your kidneys remove some as well. And, some wastes are removed by both the liver and the kidneys.

When a new medicine is prescribed for you, ask the pharmacist if your liver or your kidneys will remove the wastes. If your kidneys must remove the wastes, ask to be sure the dose is safe for you if your kidneys don’t work at 100%.

Ways to Take Medicines

Most medicines are given in one of three ways:

• As a pill, capsule or liquid you swallow
• As a liquid that is injected into the skin or muscle
• As a liquid that is flowed into a vein

When they can, doctors try to prescribe pills or capsules. But, some medicines work better or last longer if they are given by other routes. Stomach acid destroys some medicines (like insulin), so they can’t be given by mouth.

There are other ways that medicines can be given, too. Some can be given with a skin patch. Some are sprayed under the tongue. Suppositories are put into the rectum. Some medicines are inhaled, like asthma treatments.

How to Take a Pill, Softgel, or Capsule

Do you find it hard to swallow pills or capsules? These tips may help:

• Pills and softgels are heavy, and they sink. Take a sip of liquid, put the pill in your mouth, and look up at the ceiling. The pill and liquid will go to the back of your throat where they are easy to swallow.
• Capsules float. Take a sip of liquid, put the capsule in your mouth, and look down at the floor. The capsule will float to the back of your throat where it is easy to swallow.

Some people find that taking a whole pill or a capsule in a spoonful of a soft food, like pudding, helps them to swallow.

Tell Your Doctor if You Have Side Effects

Any medicine can have side effects. These may be good—minoxidil is a blood pressure pill that has the side effect of helping hair grow. But, in most cases side effects are annoying, painful, or even harmful. Or, you may have an allergy to a medicine.

Some side effects will go away in time. Some will go away if you take a medicine in a certain way—like with food or on an empty stomach. Some won’t go away, and you will need to change to a new medicine or learn to get used to them if the medicine is helping your health problem. Always tell your doctor about side effects you notice. He or she may be able to help.

Some Medicines Can Interact Badly—Watch for Symptoms

When you take two or more medicines, they may not work well together. Pharmacists have lists of problems that can occur when two medicines are taken. But when you take more than two, no one can predict what may happen.

Know your body. Make a note when you start a new medicine so you can see if it seems to be causing a new symptom or making an old one worse. If you have a new symptom, tell your doctor and your pharmacist. You may need a change in medicine, in the timing of when you take it, or in the dose.

Some Foods Can Interact with Medicines, Too

Some foods and drinks can be unsafe with prescription medicines, too. Grapefruit and other citrus fruit and juice can keep some medicines from breaking down, so they can build up to harmful levels in your body.

You may be taking medicines that are broken down by your liver. Adding alcohol puts an extra strain on your liver. Ask your doctor and your pharmacist if there are any foods or drinks that you should avoid when you take a medicine.

Herbs and Folk Remedies are Medicines—Tell Your Doctor

Sometimes people think that if a doctor doesn’t prescribe a product, it’s not a “real” medicine. Wrong!

Medicines include:

• Vitamins
• Herbal products
• Folk or traditional remedies
• Over-the-counter (OTC) products like pain pills, antacids, cold remedies, etc.

Just because something is “natural” or an herb does not mean that it is safe for you. When your kidneys don’t work as well as they should, wastes from these products can build up in your body and harm you. Or, they can react in bad ways with prescribed medicines you take.

For example, some antacids contain aluminum or magnesium. These can harm you when your kidneys don’t work well. Always tell your care team about ALL medicines you take—prescribed or not.

Know Your Medicines and What They Do for You

You owe it to yourself to know the basics about ALL of the medicines you take. That way, you can help keep mistakes from being made. It’s rare, but sometimes the wrong pills are put in the bottle at the drugstore. Or, two products with names that sound alike are mixed up. Don’t let this happen to you. Ask your care team about each medicine that is prescribed for you. It is important to know the following about each medication you take:

• What each medicine is called
• What health problem it is for
• What it looks like
• When to take it
• What to do if a dose is missed
• What side effects may occur

Labels Can Help You Take Medicines the Right Way

A prescription label has a lot of information about a medicine. (You may need reading glasses to see it!) The label will tell you the brand and generic name, the dose, how to take it, and how many refills you get. The label will also have your name, the pharmacy’s name, and your doctor’s name. There will be a prescription date and a use-by date, too.

Make a System to Help Yourself Remember

It can be hard to remember to take medicines each time you should. And, the more pills you need, the harder it can be. Figure out a way to remind yourself. Some people use pill boxes or timers on a watch or cell phone. Or, your care team may have a card with your medicines on it. Ask about it. If not, maybe you can make one for yourself.

Medicine Can Look Like Candy – Use Childproof Bottles

Each year, children are poisoned by adult medicines—like iron pills. Keep your medicines in bottles with childproof lids if there are ever any children in your home (even if they just visit now and then). If it’s hard for you to open a childproof lid, talk to the pharmacist. There may be an option that will work better for you.

High Blood Pressure is a Common Problem

High blood pressure often goes hand in hand with kidney problems. Your doctor may prescribe one or more blood pressure pills to help lower your blood pressure into the safe range.

You Can’t Feel High Blood Pressure

Some people get headaches when their blood pressure is very high. But in most cases, high blood pressure is “silent”—and you can’t feel it. Blood pressure pills only work when you take them each day as your doctor prescribes. These medicines need to build up to a certain level in your blood and stay there all the time—whether you feel like your blood pressure is high or not. They are not like pain pills that you take only when you feel pain.

Check your blood pressure at home with a blood pressure monitor to see if your treatment is working. Your VA doctor can write a prescription for a blood pressure monitor so you can get one to take home.

Diuretics (“Water Pills”) Make You Urinate More

High blood pressure can be a cause—or a result—of kidney problems. Either way, treating it can help reduce your risk of having a heart attack or a stroke. If you have a kidney problem, keeping your blood pressure in the target range can also help protect your kidneys from more damage. Exercise and diet can help treat high blood pressure. In most cases, you will need to take blood pressure pills, too. Blood pressure pills come in “classes.”

A common class of blood pressure pills is diuretics (“water pills”). These are the first pills most people get for high blood pressure. While your kidneys still work, “water pills” help rid your body of extra water and salt. This means that you will make more urine—at least for the first few weeks. This can wake you up at night. Talk to your care team about what time to take a water pill so it doesn’t affect your sleep.

Water pills are only useful while you still make urine. If your kidneys fail and you stop making urine, “water pills” won’t work.

“Water Pills” Can Change Electrolyte Levels in Your Blood

“Water pills” can change the levels of sodium and potassium (electrolytes) in your blood. You may need to have blood tests and change what you eat to be sure these levels stay in the safe range.

Having too much or not enough potassium in your blood can stop your heart—so this is important! Always tell your care team about any new symptoms you have after you start on a new medicine.

Some Blood Pressure Pills Keep Arteries Relaxed

ACE inhibitors and ARBs are two more classes of blood pressure pills. These are used often in people with kidney problems. They can help protect the kidneys from further damage if you have diabetes or another health problem where there is protein in your urine. If you are a woman, ACE inhibitors and ARBs are NOT SAFE if you become pregnant. Talk with your doctor about this.

A class of blood pressure pills called alpha blockers and one called central agonists also work by keeping your arteries relaxed. If your doctor prescribes a central agonist, it’s important to not stop taking it suddenly—your blood pressure could rise very quickly to dangerous levels.

Side Effects of ACE Inhibitors

ACE inhibitors can cause a dry, tickly cough in some people. If you take an ACE inhibitor and this happens to you, tell your doctor. You may need to switch to an ARB instead. ARBs do not cause a cough.

Some BP Medicines Slow Your Heart Rate

Beta blockers and calcium channel blockers are two more classes of blood pressure pill. If your heart rhythms are not even and you have high blood pressure, your doctor may prescribe one of these. These medicines slow your heart rate and reduce your body’s “fight or flight” response to stress. Because they can block the effects of the sleep hormone melatonin, they can cause problems sleeping. They can also make you feel tired.

If you take a calcium channel blocker, don’t drink grapefruit juice! The juice reacts with the medicine and could make it build up in your body to unsafe levels.

You May Need More Than One Type of Blood Pressure Medicine

Sometimes one blood pressure pill doesn’t do the trick. Often, people with kidney problems need to take more than one class of blood pressure pills to get their blood pressure into the target range and protect their kidneys. This may be because the kidneys are causing high blood pressure. But sometimes it happens when someone doesn’t take the pills the doctor prescribes. Then, the doctor prescribes more pills, thinking that the first one is not working.

Be honest with your care team. If a blood pressure pill is causing problems for you, say so. It’s better to switch to a new medicine than to have more and more pills prescribed and not take them.

See How You Feel Before You Get Behind the Wheel

Any medicine can cause side effects. You may be at risk of a fall or other accident. Protect yourself:

• Sit before you stand up, in case you may feel dizzy.
• See if you need help to walk.
• Don’t drive a car or run heavy machinery until you know how a new blood pressure pill makes you feel.

If you are a man, you may know that blood pressure pills can cause problems getting erections, or make this problem worse. A change in medicine or dose can help if this happens to you. Talk to your doctor—but DO take your blood pressure pills!

Keeping Your Bones Healthy

Vitamin D helps you make strong bones, and helps your body keep the right amounts of calcium and phosphorus in your blood. If you don’t have enough vitamin D, your gut can’t absorb calcium from food.

Key Players in Bone Disease

Healthy kidneys turn vitamin D from food (and the sun) into the active form your body needs. But, if your kidneys don’t work well, you may not have enough active vitamin D.

Without active vitamin D, your body can’t keep the right balance of calcium and phosphorus in your blood.

• Your calcium levels will get too low

• Your phosphorus levels will get too high

Tiny parathyroid glands in your neck will make parathyroid hormone (PTH) to try to boost the levels of calcium in your blood. But, this won’t work if you have too much phosphorus in your blood.

A vicious cycle begins. If it keeps up, your bones could get weak and break more easily.

Vitamin D May Be Given by Mouth or Injection

MANY Americans don’t have enough vitamin D, even if their kidneys are fine. The good news is, not having enough vitamin D is a problem that is easy to treat. Your doctor may ask you to take over-the-counter vitamin D pills or softgels. Or, he or she may prescribe active vitamin D. This may be given as pills or as injections.

Having the right amount of vitamin D in your blood will shut off the extra PTH so you don’t lose as much calcium out of your bones. Your blood levels of calcium will be checked to be sure they don’t go too high.

Medicine to Reduce Your PTH Levels

In some cases, vitamin D is not enough to shut off the excess parathyroid hormone. Your parathyroid glands grow larger as they struggle to keep making more PTH. In time, they can get so big that they can’t shut off. In the past, surgery had to be done to remove the glands. But now, a pill called cinacalcet can help shut off excess PTH. Your doctor may prescribe this drug for you if your PTH levels are too high.

Most of the side effects of cinacalcet are minor, like upset stomach. But some can be serious. Tell your doctor about any symptoms you have after you start ANY drug. If you take cinacalcet, be sure to call the doctor right away if you have:

• Burning or tingling of your lips, tongue, fingers, or feet
• Muscle aches or cramps, or a sudden tight feeling in the muscles of your hands, feet, face, or throat
• Seizures

Treatments for Anemia

Anemia is a shortage of oxygen-carrying red blood cells that can happen with chronic kidney disease.

The good news is, there are treatments that can help give you back some of your energy: iron and EPO.

How Your Body Makes Red Blood Cells

Your body needs both iron and the hormone erythropoietin (EPO) to make red blood cells. Iron is a building block for red blood cells. Your bone marrow is a red blood cell factory. EPO tells your bone marrow when it is time to make more red blood cells. It’s the switch that turns on the factory.

Since healthy kidneys make EPO, you may not have enough EPO if your kidneys don’t work as well as they should. Your doctor may prescribe both iron and EPO if you have anemia.

Iron Supplements by Mouth or IV

Your doctor may prescribe iron for you if the iron levels in your blood are too low. In most cases, this will be in the form of pills. Pills may not be absorbed well by your gut. Be sure to keep iron pills—and ALL of your other medicines—in bottles with childproof lids* if children come to your home. Each year, children are poisoned by medicines and some die.

If iron pills don’t give you enough iron, your doctor may prescribe iron to be given to you in a vein through an IV. This can “fill up your tank” much faster. You would need to come into the clinic for an hour or two for a nurse to give you iron.

*We all know that prescription medicines can cause harm if they are used the wrong way. But over–the-counter medicines can poison children, too! Keep ALL medicines in childproof bottles if there is any chance that a child could reach them.

EPO Treatment for Anemia

The other common treatment for anemia in people who have kidney disease is a manmade form of erythropoietin (EPO). EPO helps you make more of your own red blood cells. EPO must be injected under the skin or into a vein—there is no pill form. If you need EPO and have chronic kidney disease, you may need to come to a clinic visit to get it or learn to give it yourself.

If your kidneys fail and you do dialysis in a center, you will most likely get your EPO during your treatments. Ask what your dose is so you can track this.

FDA Warning about EPO

The U.S. Food and Drug Administration (FDA) has placed a “Black Box Warning” on EPO. The warning was added after some researchers found a higher risk of strokes and heart attacks in people with kidney disease when too much EPO was used.

But, having anemia that is not treated can also harm you. Anemia can make it hard to have the energy to get through each day and do the things you want to do. Your doctor will use the lowest dose of EPO possible. The goal is keep your red blood cell level high enough that you don’t need blood transfusions. Talk with your doctor about the benefits and risks of EPO.

Blood Transfusions Make It Harder to Get a Transplant

If your kidneys fail and you want a kidney transplant, each blood transfusion you get could make that harder. Blood is a living substance. It has immune cells from the blood donor that may react with your own blood. Most people don’t need transfusions. Good anemia treatment with iron and EPO can help you avoid them, too.

Preventing Phosphorus Build-up in Your Blood

Healthy kidneys control the levels of phosphorus in your blood. When the kidneys don’t work as well as they used to, phosphorus can build up in your blood. This can lead to severe itching and other health problems that you can prevent by taking phosphate binders.

Calcium + Phosphorus Can Harden Blood Vessels

Having too much calcium and phosphorus in your blood at the same time is a problem. The two minerals can join and form deposits in your skin, causing painful itching. Or, they can form deposits in blood vessels that may cut off blood flow to a limb. Phosphate binders can help keep your blood levels of phosphorus from getting too high.

How Phosphate Binders Work

Phosphate binders work in your gut when you eat food. They bind chemically to phosphate in your food. Then, the binders and phosphate pass out of your body in your stool.

Phosphate Binders Keep Phosphorus Out of Your Blood

Like a magnet, binders attract and hold phosphorus before it can get into your bloodstream. Taking phosphate binders and limiting high phosphorus foods go hand in hand to help you feel your best.

Types of Phosphate Binders

Some phosphate binders are calcium-based. These binders may be over-the-counter or prescription drugs. Other binders do not have calcium and may taste less “chalky.” Talk to your doctor about which type is right for you.

When to Take Phosphate Binders

You take phosphate binders WITH food. With ALL food. ONLY with food. They only work if they are in your gut at the same time that food is in your gut. When you eat a snack, you’ll take a small number of binders. With a larger meal, you’ll take more binders. Your dietitian will go over your lab test results with you to see if your phosphorus level is in the target range.

Bring Your Phosphate Binders With You

Keep some binders on hand when you’re away from home so you can take them as you need to. You can use a keychain container, pill box, or pill bottle to bring them along. Some people keep a bottle of binders in a purse or backpack.

Any time you eat, you want your binders to be on duty, cleaning up phosphorus.

Kidney Disease May Change Your Dose of Diabetes Medicines

If you have diabetes, or high blood sugar, you may be taking medicines to help control your blood sugar. If your kidneys don’t work well, some of these medicines could last longer than normal or build up to unsafe levels in your blood. (Healthy kidneys remove these medicines.) So, your dose of diabetes medicines may need to change if you have kidney disease or if your kidneys fail.

Sugar in Your Body

Use of sugar (glucose) in your body is complex. Most Americans eat far more sugar than our bodies need, as sweets and as starches like potatoes, rice, corn, and other grains. When we eat sugar, it is first absorbed in the gut.

Your pancreas makes enzymes that help you digest your food. It also makes insulin, a hormone that keeps blood sugar levels in check.

Your liver makes bile to help you digest your food. It also stores glucose and releases it if your body needs more.

Drug Classes for Type 2 Diabetes

If you have diabetes, your doctor may prescribe pills to help control your blood sugar. There are six classes of diabetes pills. They work on your gut, your pancreas, your liver, your cells, or more than one of these:

• Sulfonyureas tell your pancreas to make more insulin.
• Meglitinides also tell your pancreas to make more insulin—but only when your blood sugar is high.
• Dipeptidyl peptidase IV (DPP-IV) inhibitors, like meglitinides, tell your pancreas to make more insulin when your blood sugar is high. They also tell your liver to stop making so much sugar.
• Thiazolidinediones (TZDs) make cells more sensitive to insulin so they take more sugar out of the blood, and help the liver to make less glucose.
• Biguanides help insulin move into your cells and keep your liver from releasing glucose it has stored.
• Alpha-glucosidase inhibitors block digestion of starch in your gut so blood sugar does not go up as fast.

Some diabetes drugs combine more than one of these classes into one pill.

Avoid Metformin if You Have Severe CKD

Metformin is a strong and helpful diabetes medicine. It can be used safely in early kidney disease. But, it is NOT SAFE for you if your kidney disease is severe. If you take metformin (by any name), talk to your doctor about when you may need to switch to a drug that is safer for you.

Talk to your doctor before you stop taking any drug he or she prescribed for you.

Kidney Disease May Lower Your Need for Insulin

If you use insulin, your dose may change if you have chronic kidney disease. The kidneys help remove insulin from your blood. When your kidneys don’t work as well, less insulin may give you the same effect—or you may have more low blood sugars.

In fact, having more low blood sugars can be a sign that it’s time to have your kidneys checked. Testing your blood sugar as often as your care team advises can help you stay on track.

Talk with your care team about diabetes goals for your stage of kidney disease.

Treating High Cholesterol

Heart disease is a common health problem in the U.S. And, if you have chronic kidney disease, you are at a higher risk for heart disease than most. Keeping your heart healthy can help extend your life. Taking cholesterol medicines if your doctor prescribes them is one step you can take each day to protect your heart.

Eating a healthy diet is another way you can protect your heart. Staying active is also a great choice for heart health!

Cholesterol Forms Part of Your Cells

Your body needs some cholesterol. This waxy fat is used to make up part of the outer wall (membrane) of each cell in your body. It also:

• helps make bile so you can digest your food
• helps your body convert vitamin D to its active form
• acts as a building block for other hormones

Your liver makes cholesterol—mostly at night while you sleep—and helps recycle it to be sure you have enough.

High Cholesterol May Clog Your Arteries

Some people have too much cholesterol in their blood. Studies have linked high cholesterol with clogged arteries that can damage your heart. If your blood cholesterol levels are high, your doctor may prescribe medicine to help lower it.

Treating High Cholesterol with Statins

Medicines called statins are often used to help lower cholesterol. They work in your liver to keep cholesterol from forming. And, some studies have found that they can help melt away cholesterol plaques that have formed in your arteries. Statins may help reduce inflammation that can damage blood vessel walls. They may also reduce the rate of some types of cancer.

Report New Muscle Pain to Your Care Team

The most common side effects seen with statins are muscle aches and pains. In very rare cases, this can be due to a problem called rhabdomyolysis—a breakdown of muscle tissue throughout the body. If this happens, the wastes that result could cause sudden kidney failure. If you have muscle pain or weakness with vomiting and confusion, contact your health care team right away.

Statins + Fibrates = Greater Risk

When statins and cholesterol medicines called “fibrates” are both taken, the risk of severe muscle side effects is higher. Talk to your doctor if you take a medicine that has “fibrate” or “fibrozil” in its generic name along with a statin. Your doctor may need to change your dose or take you off one of the medicines to protect your kidneys.

CoQ10 Supplements

Taking statins can block coenzyme CoQ10 in your body. CoQ10 is a bit like a vitamin. It works inside all of your cells and is key to 95% of your body’s energy. A lack of CoQ10 has been found to be a factor in heart disease. Low levels can make you feel very tired.

Two studies have found that supplements of CoQ10 can help people with kidney problems. If you take a statin, talk to your doctor about whether CoQ10 supplements might be helpful for you.

Fish Oil Supplements

Fatty fish like salmon, trout, herring, bluefish, and sardines have oils that are good for your heart! (This works if the fish is baked or broiled. Fried fish will not help your health.) If you don’t like to eat fish, fish oil capsules may help lower your cholesterol. Studies show that fish oil can help prevent heart attacks and strokes. Talk with your care team about whether a fish oil supplement might be a good choice for you and your heart.

Treating Pain

If you take medications for pain, having kidney disease, too, may mean that your doctor will need to make changes to your pain management.

Your Kidneys & Liver Remove Drug Wastes

When you take medicines, your body breaks them down as they are used, and wastes are created. These wastes must be removed from your blood or they could build up to unsafe levels. Your liver and your kidneys remove drug wastes. Which organ does the work depends on the drug. This is true for pain medicines, too.

If you take a pain medicine like morphine that is removed by your kidneys, harmful wastes may build up in your blood if your kidneys don’t work well. Each pill may last longer. But, to avoid harm, your doctor may need to change your dose or your medicine. This is true even if you have been taking the same pain medicine for a long time.

Talk with your doctor about your pain control with kidney disease. For mild pain that you just have once in a while, ask your doctor if over-the-counter acetaminophen is a good choice.

Avoid NSAIDs

Non-steroidal anti-inflammatory pain pills, or NSAIDS, are a rare cause of kidney failure—most often if they are taken daily for a year or more. Most NSAIDS are over-the-counter, like naproxen and ibuprofen. Avoid NSAIDS as much as you can.

Some NSAIDS are prescribed by a doctor. These prescription NSAIDs include:

• Indomethacin
• Piroxicam
• Nabumetone
• Celecoxib

Talk to your care team about pain treatment that’s safe for you to use and won’t hurt your kidneys.

NSAIDs can cause chronic kidney disease (CKD) or make it get worse faster. If you have CKD, it’s best for your kidneys if you don’t take these for daily pain relief. Talk to your care team about other options to manage your pain.

Pain Management with Heat and Cold

Some types of pain can be helped with heat, cold, or switching between the two. Never use heat for more than 20 minutes at a time—it could cause nerve damage.

Keep ice in a bag or towel so it does not touch your skin. Never use ice for more than 15 or 20 minutes at a time—you could get frostbite.

Don’t use the hottest setting of a heating pad if you have diabetes. If you are not sure how to use ice or heat safely to help relieve pain, talk to your care team.

Pain Relief with Massage

Therapeutic massage can help problems like neck and back pain. Studies have found that people who get massage treatments for these problems have less pain and more function than those who don’t. Massage is just one type of pain treatment the VA can offer you if you need it.

Transcutaneous Electrical Nerve Stimulation (TENS)

A TENS unit can be used to stimulate nerves through the skin and block pain. Sometimes medicine can be given through the skin using the electrode pads. It can be helpful for chronic pain and for nerve pain in some people. If you have a pacemaker, using TENS may not be wise. Talk to your care team to learn whether TENS might help your pain.

Biofeedback May Help You Control Pain

You may be able to learn how to control the process that leads to your pain—so you have less pain. How? Through biofeedback.

First, you learn to be aware of what is going on in your body that leads to the pain. This can be done by using sensors to measure your heart rate, breathing rate, and skin temperature. You will get feedback in your patterns through a noise or a computer screen. Then, you can learn to change the patterns by watching the feedback. In time, you will be able to change your patterns without needing the feedback.

Biofeedback may help chronic pain, headaches, low back pain, anxiety, and many other problems. Talk with your VA care team if you think biofeedback might be helpful for you.

Treating Pain with Acupuncture

It may sound odd, but acupuncture and acupressure have helped people with many kinds of health problems, including pain. Acupuncture is a type of traditional Chinese medicine. Its aim is to affect the flow of energy or “Qi” (“chi”) in the body. It has been used for thousands of years and studies have found that it can help pain and nausea.

When you have a kidney problem, don’t take Chinese herbs—they can contain products that can damage your kidneys or liver.

If you have chronic kidney disease (CKD), diabetes, or high blood pressure—or if you take certain blood pressure medicines that affect your kidneys—you should take steps to protect your kidneys from harm.

ACE inhibitors and ARBs are two types of blood pressure medicine that may slow the loss of kidney function and delay kidney failure. You can tell if you’re taking one of these medicines by its generic name. ACE inhibitors end in –pril and ARBs have generic names that end in –sartan; for example, lisinopril and losartan.

You may also take a diuretic, sometimes called a water pill, to meet your blood pressure goals.

Manage your medicines with help from your health care providers

At the pharmacy

The next time you pick up a prescription or buy an OTC medicine or supplement, ask your pharmacist how the product may affect your kidneys or react with other medicines you take.

Fill your prescriptions at only one pharmacy or pharmacy chain so your pharmacist can monitor your medicines and supplements, and check for harmful interactions between your medicines.

At your doctor’s office

Keep an up-to-date list of your medicines and supplements in your wallet. Take your list with you, or bring all your medicine bottles, to all health care visits.

Be careful about using over-the-counter medicines

If you take OTC or prescription medicines for headaches, pain, fever, or colds, you may be taking a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs include popular pain relievers and cold medicines that can damage your kidneys if you take them for a long time, or lead to acute kidney injury if you take them when you are dehydrated or your blood pressure is low.

Ibuprofen and naproxen are NSAIDs. NSAIDs are sold under many different brand names, so ask your pharmacist or health care provider if the medicines you take are safe to use.

You also can look for NSAIDs on Drug Facts labels like the one below.

Plan ahead to manage pain, flu, or other illness

Almost everyone gets sick once in a while. Your doctor or pharmacist can help you plan ahead to keep your kidneys safe until you get well. Prepare in advance so you know what to do if you have pain or a fever, diarrhea, nausea, or vomiting, which can lead to dehydration.

Before you get sick, ask your health care provider or pharmacist the following questions

• If I get sick, are there medicines I should not take while I’m sick?
• If I need to stop medicines when I’m sick, when can I restart them?
• What can I take or do to relieve a headache or other pain?
• What can I take to relieve a fever?
• If I have diarrhea or am vomiting, do I need to change how or when I take my blood pressure medicine?

If blood pressure medicines help my kidneys, why all this extra caution?

In normal, everyday circumstances, taking your blood pressure medicines as prescribed helps protect your kidneys. However, certain situations, such as when you’re dehydrated from the flu or diarrhea, can lower the blood flow to your kidneys and cause harm.

Factors that can add up to cause harm

When you get sick from something like the flu or diarrhea, or have trouble drinking enough fluids, the blood pressure in your body may decrease. As a result, the pressure in your kidneys can be low, too.

In most cases, healthy kidneys can protect themselves. However, if you keep taking your blood pressure medicines when you’re dehydrated or have low blood pressure, your kidneys might have a hard time protecting themselves. The pressure within your kidneys might drop so low that your kidneys won’t filter normally.

If you’re dehydrated, NSAIDs can also keep your kidneys from protecting themselves. As a result, taking NSAIDs when you’re sick and dehydrated can cause kidney injury.

Other ways to protect your kidneys

Read about what else you can do to keep your kidneys healthy. If you already have CKD, the steps you take to protect your kidneys also may help prevent heart disease—and improve your health overall.