Renal Effects of Over‐the‐Counter Analgesics

Abstract

Recent case reports have shown that over-the-counter (OTC) analgesics, which are generally considered to be a safe treatment for minor aches and pains and fever, may cause adverse renal effects. Many renal syndromes induced by nonsteroidal antiinflammatory drugs (NSAIDs) can be attributed to prostaglandin inhibition. Fluid and electrolyte disturbances, acute renal failure, and acute interstitial nephritis also occur predominantly with NSAIDs. Acetaminophen lacks significant peripheral prostaglandin inhibition and may be a preferred first-line agent, particularly in patients susceptible to the induction of renal impairment. Apart from obvious clinical overdosage situations, limited reports of adverse renal effects exist with acetaminophen. Some studies have reported an association between analgesic nephropathy, one of the most severe analgesic-related adverse renal effects, and long-term abuse of phenacetin, acetaminophen, aspirin, ibuprofen, analgesic combinations, or other NSAIDs, although for some of these agents, this relationship is controversial. The overall risk for serious renal effects with OTC analgesics appears to be low, but given the accessibility and vast number of persons taking these agents, the absolute number of patients affected may be substantial. Therefore, it is important that healthcare providers recognize the risk factors for adverse analgesic-related renal effects.

Acute renal failure in CF patients chronically infected by the Liverpool epidemic Pseudomonas aeruginosa strain (LES)

“…These are frequently administered in adult CF patients, who may present with posture-related musculoskeletal chest or back pain as well as CF-related arthropathy. NSAIDs inhibit intrarenal production of the vasodilator prostaglandin E2 and prostacyclin, causing renal vasoconstriction and acute renal dysfunction [19]. This is relevant only in extracellular volume contracted states, when renal blood flow is dependent on prostaglandin production.…”

Ibuprofen: pharmacology, efficacy and safety

“…The issue is of probably greater concern in elderly subjects because of the higher prevalence of arthritic disease among them and the greater need for NSAID therapy (Murray and Brater 1999;Kean et al 2008). Rarely serious renal pathology has been observed with ibuprofen (Carmichael and Shankel 1985;Radford et al 1996;Cook et al 1997;Silvarajan and Wasse 1997;Brater 1998;Murray and Brater 1999) but these reactions have not been observed in trials with OTC ibuprofen (Whelton et al 1990;Whelton 1995). The evidence from literature surveys and clinical trials suggests OTC use of ibuprofen does not cause significant renal injury (Rainsford et al 1997Doyle et al 1999;Kellstein et al 1999;Hersh et al 2000a;Ashraf et al 2001;Le Parc et al 2002;Boureau et al 2004).…”

“…Overall, the data suggest that hepatic reactions are probably rarely associated with ibuprofen. Since there have been no specific indications of reports of hepatic reactions with OTC use of ibuprofen from trials (Doyle et al 1999;Kellstein et al 1999;Boureau et al 2004) or in literature analyses (Whelton 1995;Rainsford et al 1997) it is likely that hepatotoxicity is not a significant risk factor at OTC dosages.…”

Renal Papillary Necrosis—40 Years On

“…Analgesic abuse is a frequent cause of analgesic nephropathy that leads to end-stage renal disease and upper urothelial carcinoma throughout Europe (46, 47, 58-64, 179,180,203,204), Australia (149-150, 171, 216), and other parts of the world (206)(207)(208)(209)(210). Interestingly, there are apparently only few cases in the USA (21,29,56,96,184,200,201,226). The condition occurs in national or local clusters, for reasons that are not clear, but may relate to social customs, availability of specific medications, or other as yet poorly identified factors.…”