How Painkillers Ruin Your Kidneys

That ibuprofen you take could lead to kidney failure

Woman holding asprin and glass of water
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The title to this article might come across as a little bit sensationalist, but that is exactly my point. Some common painkillers, a lot of them available over-the-counter, are a significant cause of kidney failure worldwide. Almost equally uncommon is awareness that these medications can lead to kidney failure! 

Although a huge number of medications can cause kidney disease and kidney failure (antibiotics like gentamicin, chemotherapeutic agents, etc), my focus for this article is to help readers understand the effects of painkillers, specifically aspirin, acetaminophen (Tylenol), and NSAIDs (Non Steroidal Anti-inflammatory Drugs; eg ibuprofen, Advil, Aleve, Motrin, Celebrex, Indomethacin, Naproxen, etc) on kidney function.

Part of the reason this issue is extremely pertinent is related to the common use and availability of these medications. If you look at it from a public health perspective, you would realize that even if a culprit painkiller were to have a low incidence of kidney damage, you would still get a significant number of people who will sustain kidney damage from painkillers owing to their widespread use. In fact, the pain management market is only growing, and as of 2012 stood at $35 billion annually! NSAID use also continues to increase owing to concerns about the abuse potential of opiates (and so, there currently is, what the Wall Street Journal calls an arms race to develop safer, abuse resistant painkillers). 

Lets take a quick look at some common painkillers and their effect on the kidneys:


Aspirin, as an extract from the Willow bark, has been used as a painkiller for millennia. Its synthetic version was created by German chemist Felix Hoffman in 1897 (who by the way, also created Heroin for Bayer!).

This gave Bayer one of its first blockbuster pill over a hundred years ago. Aspirin is technically an NSAID. However, it also has a profound anti platelet effect which thins the blood and prevents clotting. Hence it is commonly used to prevent heart attacks in high risk individuals. There have been medical studies that have looked at aspirin's effects on the kidneys in isolation, and also in combination with other painkillers.

From what we know, aspirin use alone is not associated with an increased risk of kidney failure. 


Acetaminophen, or Tylenol, is a common painkiller. However, it is not an NSAID. These is mixed evidence whether tylenol use alone could cause kidney failure, with some studies supporting this conclusion, while others refute it. Currently, it is considered safer than most NSAIDs as far as the actions on the kidneys are concerned. However, tylenol's parent compound phenacetin has had a checkered history and has been clearly linked with kidney failure. It is no longer available (it was banned in the US in 1983). 


NSAIDs have profound effects on the kidney function. Over the short term, they reduce the kidney's blood supply by interfering with production of something called cyclooxygenase (COX - the kidneys rely on this for adequate blood supply). Over more prolonged periods of time, NSAIDs can cause tissue breakdown in the kidneys, called papillary necrosis. Eventually, the kidneys can shrink and atrophy and this disease is called Analgesic Nephropathy.

This is not the only way NSAIDs can damage the kidneys. NSAID induced kidney diseases, just to name a few, include Interstitial Nephritis, Minimal Change Disease, Membranous Nephropathy, etc. People who have Analgesic Nephropathy are at a higher risk of developing a certain cancer of the urinary tract, called Transitional Cell Carcinoma.  

The harmful effects of NSAIDs on the kidneys combined with their easy availability has prompted the National Kidney Foundation to campaign for their rational use and form an alliance to educate the public about their renal effects. 


This is a separate topic that I intend to cover in a different article. For now, a few recommendations that I could point out are that patients with kidney disease consider using acetaminophen over NSAIDs or use a drug called tramadol, which is not known to be toxic to kidneys. There are many nuances that need to be kept in mind and I will cover them all later!

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