Use of over-the-counter (OTC) medications and natural remedies is common among patients with moderate or severe chronic renal insufficiency (CRI), and some patients may be using products with contraindicated ingredients, a Canadian study revealed.

A team led by Lyne Lalonde, PhD, of the University of Montreal recruited 87 patients from a predialysis clinic in Laval, Quebec. Of these patients, 46 had moderate and 41 had severe CRI. They were interviewed by a pharmacist, and subjects were advised to have all of their OTC medications and natural products available at the time of the interview.

Use of OTC drugs was reported by 83% and 68% of those with moderate and severe CRI, respectively, investigators reported in the American Journal of Kidney Diseases (2007;49:245-256). Use of natural products was reported by 22% and 29%, respectively. Overall, 9% patients reported taking at least one contraindicated OTC and 3% reported at least one contraindicated natural product.

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“These results emphasize the importance for community pharmacists to closely monitor the use of these products in patients with chronic renal insufficiency,” the authors concluded.

Contraindicated OTC medications that subjects reported using included cold and cough remedies that contain ammonium chloride (which could cause urolithiasis and metabolic acidosis), ibuprofen (which may cause interstitial nephritis, nephritic syndrome, and other problems) and potassium bicarbonate (which may cause hypertension).

Contraindicated natural products included those containing horse chestnut (which may cause toxic nephropathy and interact with anticoagulant and antiplatelet drugs) and juniper berry (which may interact with diuretic drugs and cause kidney irritation).