Safe Medicine Use for Keeping Kidneys Healthy March 1, 2017 Katherine N. Gharibian, PharmD Assistant Professor School of Pharmacy Medical College of Wisconsin
Agenda What do the kidneys do and why are they so important? What is kidney disease and what are its causes? How do over-the-counter (OTC) pain medications cause kidney disease and what can you do to prevent it? Safe medication disposal Q and A 2
What are the kidneys? Bean-shaped organ Many important roles: Remove waste products from your body Remove excess fluid from your body Produce hormones that: Control your blood pressure Help produce red blood cells Help maintain healthy bones 3
How do the kidneys work? 4
What is Chronic Kidney Disease (CKD)? Progressive and irreversible reduction in kidney function 26 million American adults are estimated to have CKD Tests for kidney disease Urine test Check for protein in urine (there should be none) Blood test Check level of creatinine in blood, which is used to estimate your kidney function or glomerular filtration rate (GFR) 5
Stages of Chronic Kidney Disease Stage Description Glomerular Filtration Rate (GFR) 1 Kidney damage (e.g. protein in urine) 90 or above with normal GFR 2 Kidney damage with mild decrease 60 to 89 in GFR 3a Mild to moderate decrease in GFR 45 to 59 3b Moderate to severe decrease in GFR 30 to 44 4 Severe reduction in GFR 15 to 29 5 Kidney failure Less than 15 6
What causes CKD and who is at risk? Diabetes (uncontrolled) High blood pressure (uncontrolled) Glomerulonephritis Polycystic kidney disease Kidney stones Drugs and toxins 7
Over-the-Counter Pain Medicines 8
What are NSAIDs? NSAID = NonSteroidal Anti- Inflammatory Drug Relieve pain and fever Reduce swelling from muscle sprain or strain (anti-inflammatory) 9
NSAIDs: A Wolf in Sheep s Clothing NSAIDs disrupt blood flow to the kidneys and can harm the kidneys Other serious side effects of NSAIDs include: stomach bleeding increased blood pressure increased risk for heart attack and stroke (with the exception of aspirin) 10
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Ibuprofen Naproxen Aspirin Acetaminophen Also known as: Motrin IB, Advil Aleve Bayer Aspirin, Ecotrin, Bufferin Tylenol NSAID? Yes Yes Yes No Best for: Fever Muscle aches Inflammation Fever Muscle aches Inflammation Fever Muscle aches Inflammation Fever Headache Arthritis Normal dose: 1-2 tablets (200-400 mg) every 4-6 hours 1-2 tablets (220-440 mg) every 8-12 hours 1-2 tablets (325-650 mg) every 4 hours 325-1300 mg every 4-8 hours Maximum dose: 6 tablets (1200 mg/day) 3 tablets (660 mg/day) 12 tablets (3900 mg/day) 4000 mg/day Do not take for more than: 10 days for pain 3 days for fever 10 days for pain 3 days for fever 10 days for pain 3 days for fever 10 days for pain 3 days for fever Toxicity: Kidney damage Stomach bleeding Heart attack Stroke Kidney damage Stomach bleeding Heart attack Stroke Kidney damage Stomach bleeding Liver damage 12
What else can I take for pain? Use topical pain relievers Hot or cold packs or patches e.g. heating pad, Thermacare, frozen peas Aspirin ( salicylate ) e.g. Aspercreme, Sportscreme, Salonpas Camphor and menthol e.g. Tiger Balm, Thera-Gesic Capsaicin e.g. Zostrix, Capzasin 13
General considerations with pain medicine Avoid NSAIDs if you have kidney disease, are older (over 60), or take blood pressure medication. Avoid drinking alcohol while taking any pain medicine. Try alternating doses of NSAID and acetaminophen to minimize risk and maximize benefits. Take the smallest effective dose for the shortest amount of time Do not take NSAIDs for more than 10 days for pain. Read labels carefully. Talk to your health care provider. 14
Safe Medication Disposal Why should I care? 1. Drug overdose is now THE leading cause of accidental death among adults in the US, surpassing the number of traffic deaths In 2013, 15% of WI high school students reported using a prescription drug without a prescription 15
Safe Medication Disposal Why should I care? 2. In 2008, the Associated Press published a report that found that at least 46 million Americans are supplied with water that has tested positive for trace amounts of pharmaceuticals. http://hosted.ap.org/specials/interactives/_national/pharmawater_update/index.html 16
Safe Medication Disposal Store prescription pain medications in a secure place such as a safe or locked cabinet NEVER flush or drain any medication Safe methods for disposal: Drug Take-Back Day Event NEXT Drug Take-Back Day Saturday, April 29, 2017 Local Police Departments (call ahead of time) Call your local pharmacy or search for a site: (WI) http://doseofrealitywi.gov/drug-takeback/ (US) https://www.deadiversion.usdoj.gov/drug_disposal/index.html 17
For more information Your Kidneys: Master Chemists of the Body https://www.kidney.org/sites/default/files/docs/masterchemists.pdf GFR (Glomerular Filtration Rate) A Key to Understanding How Well Your Kidneys Are Working https://www.kidney.org/sites/default/files/11-10-1813_gfr.pdf Pain Medicines and Your Kidneys, What You Need to Know https://www.kidney.org/sites/default/files/01-10-7201.pdf 18
or contact: 1-800-543-6393 info@kidneywi.org 19
THANK YOU Katherine N. Gharibian, PharmD Assistant Professor School of Pharmacy Medical College of Wisconsin 20