Key takeaways:
Certain medications, called nephrotoxic medications, can damage your kidneys. They can make it harder for your kidneys to filter waste and other substances from your bloodstream.
Nonsteroidal anti-inflammatory drugs (NSAIDs), diuretics, and angiotensin-converting enzyme (ACE) inhibitors have all been linked to kidney problems.
Certain medications given in hospitals, like iodinated radiocontrast, vancomycin, and aminoglycoside antibiotics, can also hurt your kidneys.
It’s important to talk to a healthcare professional to learn how your medications may affect your kidney health.
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Your kidneys are part of a well-designed filtering system in your body. They remove toxins, waste, and extra fluid from your blood and turn it into urine.
If your kidneys get injured or damaged, they can’t filter out waste like they’re supposed to. Certain health conditions, such as diabetes and high blood pressure, can cause kidney damage. And several medications can also harm your kidneys.
Medications that are harmful to your kidneys are called nephrotoxic medications. Some of these only cause small changes in kidney function, while others could cause more serious injury. Your risk for kidney damage depends on your individual health conditions and the medications you’re taking.
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Below are the top 10 medications that have been linked to kidney damage. But this list doesn’t include everything, so talk to a healthcare professional about your full medication list. They can help you understand how each one may affect your kidney health.
1. NSAIDs, like ibuprofen
Nonsteroidal anti-inflammatory drugs (NSAIDs) are popular remedies for pain and fever. And they’re widely used to help with conditions like rheumatoid arthritis, menstrual pain, and inflammation.
Some common NSAIDs include:
While NSAIDs like ibuprofen are generally well-tolerated, taking them does pose some risks. These medications can reduce blood flow through the kidneys, which can contribute to kidney damage or even kidney failure. People with heart failure, liver disease, or existing kidney problems have a higher risk of new or worsening kidney problems when taking NSAIDs.
In general, it’s best to take NSAIDs sparingly. Take the lowest effective dose and use them for the shortest time possible. Taking NSAIDs once in a while, and only as directed, is much less likely to cause kidney damage.
2. Diuretics, like hydrochlorothiazide
Diuretics, also called water pills, treat health conditions such as high blood pressure and heart failure. Popular diuretics include:
Furosemide (Lasix)
Spironolactone (Aldactone)
Triamterene (Dyrenium)
Diuretics are usually well tolerated, but like all medications, they can cause side effects. One potential side effect is acute kidney injury, especially in older adults. This is likely because diuretics lower blood volume, which disrupts the filtration process.
But diuretics aren’t always bad for your kidneys, especially when taken at recommended doses. Kidney damage is more likely with higher doses of diuretics.
3. ACE inhibitors, like lisinopril
Angiotensin-converting enzyme (ACE) inhibitors can be both good and bad for your kidneys. These medications are easy to recognize because their names end in “-pril,” such as:
Lisinopril (Zestril)
Benazepril (Lotensin)
Enalapril (Vasotec)
Ramipril (Altace)
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ACE inhibitors are usually used to treat high blood pressure and heart failure. And in many cases, they can help protect your kidneys. But ACE inhibitors are cleared out of your body through your kidneys. This means they may still be able to cause kidney injury.
You’re more likely to have kidney problems related to an ACE inhibitor if you’re dehydrated or taking other nephrotoxic medications. In either case, you’ll likely start on a lower dose. Your prescriber may also recommend regular blood tests to monitor your kidney health over time.
4. Contrast dyes
Contrast dyes are often used during radiographic testing, such as a CT scan. The dyes make it easier to find any issues in your organs and blood vessels during the scan. But contrast dyes can sometimes lead to kidney injury.
This type of kidney injury usually appears within 24 to 48 hours of receiving the contrast. Your risk is higher if you:
Take other nephrotoxic medications
If you’re at higher risk, a healthcare professional will often lower the amount of contrast dye that is used during the test.
5. Vancomycin
Vancomycin is an antibiotic used to treat certain bacterial infections like methicillin-resistant Staphylococcus aureus (MRSA). It’s often used in the hospital if you have a serious infection.
Kidney damage from vancomycin usually happens within 2 to 3 weeks of starting the medication. And kidney function usually improves after treatment is stopped. While you’re receiving vancomycin, your healthcare team will closely monitor you with each dose.
6. Aminoglycoside antibiotics, like gentamicin
When given as an intravenous (IV) infusion, aminoglycoside antibiotics are known for causing kidney injury. Some people are at higher risk of kidney damage from these medications, including those who:
Have chronic kidney disease
Are dehydrated
Have been taking the antibiotics for longer than 10 days
Common IV aminoglycoside antibiotics include:
These medications are typically only used in hospital settings. This allows for close monitoring during treatment. A healthcare professional may adjust the dose to reduce your risk of kidney injury based on your medical history and treatment response.
7. HIV medications, like Truvada
Certain human immunodeficiency virus (HIV) medications have been linked to kidney damage. Tenofovir disoproxil fumarate (Viread) can cause acute kidney injury in certain situations. It’s often used alone and in combination products like Truvada and Stribild. Another HIV medication, atazanavir (Reyataz), has also been linked to kidney problems.
It’s important that anyone planning to take these medications should first be screened for kidney problems. People with existing kidney problems may need to take a lower dose to be safe.
Not all HIV medications carry this same risk. A newer type of tenofovir, tenofovir alafenamide (Vemlidy), is less likely to harm your kidneys. This is also true for combination medications like Descovy and Biktarvy.
8. Other antiviral medications
Acyclovir (Zovirax) and ganciclovir are antivirals that can also cause kidney injury. These medications can form crystals that don’t dissolve in urine. These crystals can cause blockages in your kidney’s filtration system. This side effect is more likely in people who are dehydrated or have existing kidney disease.
Foscarnet is another medication that can damage your kidneys. It’s used to treat viral infections. It’s not a commonly prescribed medication. But it can cause kidney damage rather easily. Because of this risk, a healthcare professional will closely track your kidney function during treatment.
9. Zoledronic acid
Zoledronic acid (Reclast) belongs to a group of medications called bisphosphonates. These are used to treat osteoporosis. Kidney damage is a rare but serious side effect of zoledronic acid. And the FDA issued a formal warning about this risk.
In general, Reclast shouldn’t be given to people with abnormal kidney function or preexisting kidney damage. This is also true for Zometa, another version of zoledronic acid used to treat high calcium levels that can occur with certain types of cancer.
10. Calcineurin inhibitors, like tacrolimus
Calcineurin inhibitors, such as cyclosporine modified (Neoral) and tacrolimus (Prograf), are immunosuppressants. They’re commonly prescribed to people who have had an organ transplant. These medications have the potential to cause kidney damage.
Even so, the benefits of these life-saving medications often outweigh the potential risk of kidney damage. But it’s still good to keep in mind. The risk of kidney damage is worse with higher doses and in people who are already at risk of kidney damage. If you take cyclosporine or tacrolimus, your prescriber will likely monitor your kidneys.
When to seek care if you think medication is causing kidney problems
It’s not always easy to tell if you have kidney damage. You might not experience any symptoms. In fact, the early signs of kidney damage can be subtle, and a healthcare professional may only notice its signs after running certain lab tests.
But if you notice any of these symptoms, you should seek care from a primary care professional right away:
Blood or foam in your urine
Dark-colored urine
A noticeable change in urinary frequency
Lower back or flank pain
Less urine than usual or difficulty urinating
If you have any of these symptoms, a healthcare professional will likely order lab tests to check your kidney health. Based on these results and the medications you take, you may need to stop or pause treatment. In some cases, you may be able to switch to a medication that’s safer for your kidneys.
Frequently asked questions
Some supplements can have a negative effect on your kidneys. High doses of vitamin C can lead to kidney stones. Other supplements, like creatine, licorice root, and cat’s claw, have also been linked to kidney injury. It’s important to talk to a healthcare professional about all the supplements you take. This is especially important if you have a history of kidney failure, are on dialysis, or have had a kidney transplant.
Most of the time, IV fluids actually help protect your kidneys. They increase blood volume, which improves blood flow to your organs, including your kidneys. But research has shown that too much IV fluid can sometimes cause kidney swelling and injury.
High blood pressure and diabetes are the two main causes of kidney damage. Managing these conditions is one of the best ways to protect your kidneys. By keeping your blood pressure in the normal range and your blood sugar stable, you reduce any further damage to your kidneys. Another important step is to avoid the daily use of over-the-counter NSAIDs or taking other medications that can damage your kidneys over time.
Whether kidney damage can be reversed depends on the cause. Acute kidney injury (AKI) is often reversible and may improve with treatment, like fixing dehydration or stopping a problem medication. Chronic kidney disease (CKD) usually doesn't go away. It’s often caused by long-term issues like high blood pressure or diabetes. Both conditions should be managed by a healthcare professional to protect kidney health.
Some supplements can have a negative effect on your kidneys. High doses of vitamin C can lead to kidney stones. Other supplements, like creatine, licorice root, and cat’s claw, have also been linked to kidney injury. It’s important to talk to a healthcare professional about all the supplements you take. This is especially important if you have a history of kidney failure, are on dialysis, or have had a kidney transplant.
Most of the time, IV fluids actually help protect your kidneys. They increase blood volume, which improves blood flow to your organs, including your kidneys. But research has shown that too much IV fluid can sometimes cause kidney swelling and injury.
High blood pressure and diabetes are the two main causes of kidney damage. Managing these conditions is one of the best ways to protect your kidneys. By keeping your blood pressure in the normal range and your blood sugar stable, you reduce any further damage to your kidneys. Another important step is to avoid the daily use of over-the-counter NSAIDs or taking other medications that can damage your kidneys over time.
Whether kidney damage can be reversed depends on the cause. Acute kidney injury (AKI) is often reversible and may improve with treatment, like fixing dehydration or stopping a problem medication. Chronic kidney disease (CKD) usually doesn't go away. It’s often caused by long-term issues like high blood pressure or diabetes. Both conditions should be managed by a healthcare professional to protect kidney health.
The bottom line
There are several medications and supplements that can cause kidney damage. Common medications like nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors, and diuretics can lead to kidney damage. Certain antibiotics given only in hospital settings can also damage your kidneys. If you’re taking a medication that can put your kidney function at risk, your prescriber will check your kidney health over time.
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References
Chaumont, M., et al. (2016). Acute kidney injury in elderly patients with chronic kidney disease: Do angiotensin-converting enzyme inhibitors carry a risk? The Journal of Clinical Hypertension.
Everson, M., et al. (2020). Contrast-associated acute kidney injury. BJA Education.
Ferraro, P. M., et al. (2016). Total, dietary, and supplemental vitamin C intake and risk of incident kidney stones. American Journal of Kidney Diseases.
Ghlichloo, I., et al. (2023). Nonsteroidal anti-inflammatory drugs (NSAIDs). StatPearls.
Gupta, S. K., et al. (2019). Renal safety of tenofovir alafenamide vs. tenofovir disoproxil fumarate – a pooled analysis of 26 clinical trials. AIDS.
Kim, S. Y., et al. (2012). Drug-Induced nephrotoxicity and its biomarkers. Biomolecules & Therapeutics.
National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Preventing chronic kidney disease.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Your kidneys and how they work.
National Kidney Foundation. (2024). Acute kidney injury (AKI).
National Kidney Foundation. (2025). Herbal supplements and kidney disease.
Prowle, J. R., et al. (2010). Fluid balance and acute kidney injury. Nature Reviews Nephrology.
Snively, C. S., et al. (2004). Chronic kidney disease: Prevention and treatment of common complications. American Family Physician.
U.S. Food and Drug Administration. (2018). FDA drug safety communication: New contraindication and updated warning on kidney impairment for Reclast (zoledronic acid).
Wearne, N., et al. (2020). HIV, drugs and the kidney. Drugs in Context.
