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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Medicines and products to avoid

No doses on this page

This handbook never gives insulin or medicine doses and never tells you to change one. Your prescriber sets every dose and every change, and writes down when to pause a medicine and when to restart it. A low blood glucose is always treated straight away: see Treating a low and Get help now.

In short

Some everyday medicines and products are risky with kidney disease. Pain pills such as ibuprofen, some laxatives and enemas, magnesium antacids, salt substitutes and some cold medicines can harm the kidneys or build up minerals your kidneys can no longer remove. Before you take anything new, including things bought off the shelf, tell the pharmacist or prescriber: "I have kidney disease, stage ___, and type 1 diabetes." KDIGO encourages people with kidney disease to tell every prescriber, and to bring their latest eGFR result and a medicine list to appointments (KDIGO 2024, practice points 4.1.3 and 4.3.1.1). This page lists what to avoid and what to ask for instead.

The products to avoid

Avoid these unless your kidney team has said yes for you.

Product Common examples Why it is risky with kidney disease Ask about instead
NSAID pain relievers ibuprofen (Advil, Motrin), naproxen (Aleve), high-dose aspirin; also hidden in many cold, flu and "PM" products They cut blood flow to the kidneys and can cause sudden kidney injury; they also raise potassium and blood pressure. NKF says people with kidney disease should avoid them, especially with an eGFR under 60 (NKF; KDIGO 2024, section 4.1 and Tables 26 and 31) Acetaminophen (Tylenol, paracetamol) within the label limit is usually preferred; ask your team (KDIGO 2024, Table 31; NKF)
Sodium phosphate laxatives and enemas Fleet-type enemas, sodium phosphate "saline" laxatives The FDA warns they can cause serious harm to the kidneys and heart, severe dehydration, dangerous changes in blood minerals, and death. The risk is highest with kidney disease, dehydration or age over 55, or with diuretics, ACE inhibitors, ARBs or NSAIDs (FDA) A laxative your team picks for you
Magnesium laxatives and antacids milk of magnesia, magnesium citrate, Epsom salts, Maalox- or Mylanta-type antacids Magnesium builds up when the kidneys fail and can reach dangerous levels (case report; StatPearls) Ask which antacid or laxative is safe
Aluminum antacids aluminum hydroxide antacids Aluminum builds up with kidney disease. KDIGO advises against long-term use of aluminum phosphate binders, the same compound, to prevent aluminum poisoning (KDIGO 2017 CKD-MBD, recommendation 4.1.7) Ask your pharmacist
Fizzy antacid and pain tablets Alka-Seltzer Original Each tablet contains aspirin, which is an NSAID. Each tablet also holds 567 mg of sodium. The label says to ask a doctor first if you have kidney disease or a sodium limit (Alka-Seltzer label) Ask your pharmacist
Salt substitutes NoSalt, Nu-Salt, Lite Salt, "half salt" They contain potassium chloride. NoSalt lists 640 mg potassium per ¼ teaspoon, and its label tells people with kidney disease to ask a doctor first; Morton Lite Salt lists 350 mg potassium plus 290 mg sodium (NoSalt and Nu-Salt labels; Lite Salt label; NKF). The risk is higher with an ACE inhibitor, ARB or finerenone (KDIGO 2024, Table 26; Kerendia label, section 17) Herbs, spices, lemon, vinegar (Sodium)
Decongestant tablets pseudoephedrine (Sudafed), phenylephrine (Sudafed PE); also in many cold and allergy combinations Their labels say to ask a doctor first if you have high blood pressure, heart disease or diabetes (Sudafed labels). In Europe, pseudoephedrine must not be used with severe kidney disease or severe or uncontrolled high blood pressure (EMA). The FDA has proposed removing phenylephrine tablets from sale because they do not relieve a blocked nose (FDA) Ask your pharmacist for a kidney-safe cold remedy

Combination cold and flu products

One bottle or packet can hold an NSAID, a decongestant and sugar all at once. For example, Sudafed PE Head Congestion + Pain contains ibuprofen (Sudafed labels). Check the active ingredients for the word "NSAID", and ask the pharmacist before buying (NKF).

Medicines that need a kidney check

These are not "never" medicines, but the prescriber and pharmacist must know about your kidneys:

  • Trimethoprim (in Bactrim and Septra, often used for urine infections) can raise potassium and also raises the creatinine number (KDIGO 2024, Tables 26 and 31). Ask whether you need a potassium check while you take it (KDIGO 2024, practice point 4.1.2).
  • Stomach-acid pills (proton pump inhibitors, such as omeprazole) used for a long time have been linked with kidney injury. Ask whether you still need one (KDIGO 2024, Table 31).
  • Medicines cleared by the kidneys often need a lower dose or a longer gap between doses. Ask the pharmacist to check each new prescription against your latest eGFR (KDIGO 2024, practice point 4.2.1; NIDDK).
  • If you take finerenone, many other medicines interact with it, and grapefruit is off limits (Kerendia label; Kidney-protecting medicines).
  • If you wear a CGM, some medicines change its readings. Ask your pharmacist to check (ADA 2026 §7, recommendation 7.20; Insulin on dialysis).

What to do

  • Say "I have kidney disease, stage ___, and type 1 diabetes" every time you get a new medicine.
  • Use one pharmacy, so it can check every medicine against the others (NIDDK).
  • Go through your medicine cabinet. Set aside anything in the table above and ask your team about it.
  • Read the active ingredients on every cold, flu, sleep and pain product before you buy it.
  • Ask your team now what to use for pain, fever, colds and constipation, so you know before you need it.
  • Print the card below and keep it with your medicine list (Your medicine list).

Examples

  • A headache. Tom reaches for ibuprofen. He checks his card and takes acetaminophen instead, staying within the label limit, as his team agreed.
  • A cold. Ana picks up a "max strength cold and flu" pack. The label lists an NSAID and pseudoephedrine. She puts it back and asks the pharmacist for something kidney-safe.
  • Constipation. Ben's bowels have been slow for a week. He does not use a Fleet-type enema or milk of magnesia. He calls his team, who suggest a laxative that suits him. Constipation also raises potassium, so treating it matters (KDIGO 2024, Table 25).

A card for the pharmacy

I have chronic kidney disease and type 1 diabetes

Stage: __ eGFR: _ (date ___) On dialysis: yes / no Transplant: yes / no

Please check every medicine, including over-the-counter products, against my kidney function.

I avoid: NSAIDs (ibuprofen, naproxen, high-dose aspirin) · sodium phosphate laxatives and enemas · magnesium and aluminum products · potassium salt substitutes · decongestant tablets

Allergies: ____ My pharmacy: ____

Kidney team: ____ Diabetes team: ____

Ask your care team

  1. Which pain reliever is safest for me, and what is my limit?
  2. What should I use for constipation, heartburn and colds?
  3. Is there anything in my medicine cabinet I should stop or throw away?
  4. Do any of my prescriptions need a dose check for my current kidney function?
  5. Is the low-dose aspirin I take for my heart all right? (Do not stop a prescribed aspirin without asking.)

Get help now if…

  • After a laxative or enema: severe weakness, confusion, very slow breathing or fainting: call 911 (or your local emergency number). These can be signs of a dangerous magnesium level (StatPearls).
  • After a sodium phosphate laxative or enema: dry mouth and thirst, much less urine, light-headedness when you stand, drowsiness, or swelling of the ankles, feet or legs: call your team today, or get urgent care if you cannot reach them (FDA).
  • After a new medicine: swelling of the lips, tongue or throat, or trouble breathing: call 911.
  • After a new medicine: much less urine than usual, new swelling, or muscle weakness: call your team today. See Get help now.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.