Pharmacy remedies and kidney disease

"People with low levels of kidney function whose kidney disease is advanced have to be the most careful," says consultant renal physician, Professor Donal O'Donoghue.

"Most people with mild to moderate kidney disease who are otherwise healthy can safely take the same over-the-counter remedies as the rest of the population.

"Whatever the stage of your kidney function, however, I'd always recommend talking to your pharmacist or doctor before taking over-the-counter remedies, so you can weigh up the risks and benefits."

According to Professor O'Donoghue, you're at higher risk of being harmed by certain over-the-counter remedies if:

• you become dehydrated (for instance, with diarrhoea and vomiting) or have a feverish illness
• you have advanced kidney disease (stage 4 or 5, or a kidney function below 30% of normal)
• you have mild to moderate kidney disease (stage 3 with a kidney function between 30% and 60% of normal) and are elderly with another serious illness, such as coronary heart disease

Here is a list spelling out which over-the-counter remedies are safe for you to use if you have kidney disease and which you should avoid. This is just a guide. For more detailed information, consult your pharmacist, renal specialist or GP.

Headache remedies

What's safe:

Paracetamol is safe and the best choice of painkiller to treat a headache. However, you should avoid soluble paracetamol products, as they are high in sodium.

What to avoid:

If your kidney function is less than 50%, avoid painkillers containing aspirin, ibuprofen or similar drugs, such as diclofenac, which has recently become available as Voltarol Pain-eze tablets. These products can deteriorate the function of damaged kidneys.

You should also avoid ibuprofen if you're taking anti-rejection treatment after a kidney transplant.

Low-dose aspirin of 75-150 milligrams (mg) a day can be used if it's prescribed for the prevention of vascular disease.

Cough and cold medicines

Many of the products available for coughs and colds contain a mixture of ingredients, so check the packaging carefully.

What's safe:

Any product that contains paracetamol.

What to avoid:

Some cough and cold remedies contain high doses of aspirin, which it's best to avoid.

Many cold remedies also contain decongestants, which you should avoid if you have high blood pressure.

The best way to clear congestion is by steam inhalation with menthol or eucalyptus. For coughs, try a simple linctus or glycerine honey and lemon to soothe your throat.

Muscle and joint pain relievers

What's safe:

If you have muscle or joint pain, it's best to use skin creams and lotions such as Deep Heat, Ralgex and Tiger Balm, which you rub on to the painful area.

What to avoid:

Avoid tablets containing ibuprofen or similar drugs, such as diclofenac, if your kidney function is below 50%.

Ibuleve (ibuprofen-containing) gel or spray is safer than ibuprofen tablets. However, it isn't completely risk-free, as a small amount of the drug penetrates your skin and goes into the bloodstream.

Indigestion remedies

What's safe:

For occasional treatment of indigestion, Gaviscon liquid or tablets are safe, as are Remegel and Rennie tablets, which contain calcium carbonate.

What to avoid:

Don't use Gaviscon Advance to treat indigestion, as it contains potassium. Avoid aluminium- or magnesium-containing medicines, such as Aludrox or Maalox, unless they're prescribed by a renal doctor.

Heartburn remedies

What's safe:

Ranitidine (Zantac), famotidine (Pepcid) and omeprazole (Losec) are safe to use for short-term relief of heartburn.

What to avoid:

Avoid cimetidine (Tagamet) for heartburn, as it can lead to a rise in the blood test for creatinine, making it seem as if your kidney function has worsened.

Hay fever and anti-allergy medicines

What's safe:

Antihistamine tablets, nasal sprays and eye drops, including well-known brands such as Piriton (chlorpheniramine) and Clarityn (loratadine), are safe to take to relieve allergy symptoms. Preparations containing sodium cromoglycate, such as Opticrom Eye Drops, are also safe.

If you use Zirtek (cetirizine) and your kidney function is below 50%, you will need to either reduce the dose you take, take it only every other day, or avoid it altogether. Your doctor or pharmacist can advise you.

Read more about antihistamines.

Multivitamins

What's safe: any vitamin preparation that doesn't contain vitamin A

What to avoid: multivitamins containing vitamin A as they may be toxic. Vitamin A is cleared from the body by the kidney but no one knows at what dose kidney function is reduced.

Effervescent vitamin tablets can contain up to 1 gram (g) of salt per tablet. Switch to a non-effervescent tablet if you've been advised to watch or reduce your salt intake.

Constipation remedies

What's safe:

You can use Senna tablets to treat constipation. If your constipation continues, you should speak to your GP.

What to avoid:

Fybogel only works if you drink a lot, so it's not suitable for people with kidney disease.

Diarrhoea remedies

What’s safe:

You can use liquid Loperamide (Imodium) to treat diarrhoea.

If you have diarrhoea and vomiting and kidney problems, you should see your doctor or pharmacist for advice.

Complementary remedies

What's safe:

Homeopathic medicines are safe for kidney patients.

Read more about homeopathy.

What to avoid:

Avoid herbal medicines if you have kidney disease, because they can raise blood pressure. Some, such as St John's Wort (for low mood), can interact with medicines prescribed for kidney disease. Others, such as echinacea (used as a colds and flu remedy), can directly affect kidney function, so you should get advice from your doctor or pharmacist before using them.

Another problem is that different brands (and even different batches of the same brand) of herbal remedy can vary widely in terms of the amount of active ingredient they contain. This makes it difficult to predict how strong a dose will be.

Read more about how your pharmacist can advise you on over-the-counter medicines and kidney disease.