CKD Medication Guide

Paracetamol up to 1 g every 6 hours (max 4 g/day for adults) is generally safe at all CKD stages. Codeine and tramadol can be used for stronger pain but cause constipation — already a problem in CKD. Opioids need lower doses in advanced CKD because they accumulate. NSAIDs (ibuprofen, naproxen, diclofenac, high-dose aspirin) are the main class to avoid — they constrict blood flow to the kidney and can cause irreversible damage, especially when combined with ACE inhibitors, ARBs or diuretics.

ACE inhibitors and ARBs protect kidney function in most CKD patients but can raise potassium and creatinine slightly at initiation. Your team monitors this. Diuretics (furosemide, bendroflumethiazide) help fluid and blood pressure control but can worsen dehydration and electrolyte disturbance if overused. Potassium-sparing diuretics (spironolactone, eplerenone, amiloride) are often restricted in CKD because of hyperkalaemia risk.

Metformin is usually reduced or stopped when eGFR drops below 30 ml/min/1.73 m² because of lactic acidosis risk. SGLT2 inhibitors (dapagliflozin, empagliflozin) are kidney-protective in diabetes but may need dose adjustment at very low eGFR. GLP-1 receptor agonists (liraglutide, semaglutide) are generally safe in CKD and may slow progression. Insulin dosing often needs reduction as kidney function declines because insulin is renally cleared.

Many herbal remedies contain potassium, magnesium or active compounds not declared on the label. St John's wort interacts with transplant immunosuppressants. Liquorice root raises blood pressure. 'Kidney cleanse' teas often contain diuretic herbs that disturb electrolytes. Always bring a list of supplements to your renal clinic.

Always mention that you have CKD when buying over-the-counter medicines. Ask them to check for NSAIDs, hidden sodium (effervescent tablets), potassium supplements, and decongestants that raise blood pressure. Many UK pharmacies can flag renal contraindications on their dispensing system.