NSAIDs can pose a risk to your kidney health. But while acetaminophen may be safer, all pain medications should be taken with a doctor’s supervision if you have kidney disease.

It’s almost a reflex: You have an ache or pain, so you reach for an over-the-counter (OTC) pain medication. But as routine as this behavior is, not everyone should casually take pain medications, as there can be potential negative interactions.

For example, people with kidney damage or reduced kidney function might not be able to use every OTC pain medication. Let’s look at why and what you can safely do for pain relief.

Before taking any pain medication, you should speak with your physician or a health professional to determine any possible interactions or risks that you might encounter. However, for most people with normal kidney function, aspirin tends to be the safest option as long as you don’t exceed the recommended doses.

If you have kidney problems

But for people with kidney disease, aspirin can increase the risk of bleeding. And in those with reduced kidney function, aspirin is not recommended unless prescribed by a physician. The recommended alternative can vary depending on the type and severity of kidney problems that you have.

Often, acetaminophen (Tylenol) is the preferred alternative. But it’s encouraged that you use the lowest dose possible that still manages pain or fever symptoms. And likewise, you should not exceed more than 3,000 milligrams per day.

Alternatively, if an OTC acetaminophen drug doesn’t control pain symptoms, a physician may suggest a temporary prescription alternative like tramadol.

Which pain medication is safe for kidney transplant patients?

Similar to people with kidney disease, transplant recipients should only consider acetaminophen to manage post-operative pain symptoms. Again, best practices include using the lowest dose possible and never exceeding 3,000 milligrams per day.

Which pain medication is safe for kidney stones?

The short answer to this question is, it depends. If a patient has kidney stones with no underlying renal issues, then any OTC pain medication can be used to manage the pain symptoms associated with passing a kidney stone.

This includes ibuprofen, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen. Multiple studies and reviews have consistently shown positive patient outcomes when using OTC medications of all types to treat pain associated with renal colic or passing a kidney stone.

However, if someone also has impaired kidney function and kidney stones, NSAIDs are not recommended. A physician will provide the best guidance, but typically, sticking with acetaminophen is the best choice for managing kidney stone pain when you have kidney disease or impaired kidney function.

Misusing any pain medication can increase your risk of kidney damage. This includes aspirin, ibuprofen, acetaminophen, NSAIDs, and of course, prescription opioid medications. The most common risks center around consuming too high a dose or taking medications for longer than recommended.

But of all the OTC pain medication categories, NSAIDs pose the greatest risk of continuous kidney damage. Specifically, these medications can increase the risk of progressive kidney damage or sudden kidney failure.

A 2019 study involving over 764,000 U.S. Army officers found that participants who were prescribed more than seven daily doses of NSAIDs per month had an increase in the potential for an acute or chronic kidney disease diagnosis.

Still have questions about pain relief and your kidneys? Here’s a roundup of the most commonly asked questions.

How can you prevent kidney damage from NSAIDs?

If you have kidney disease or reduced kidney function, avoid taking NSAIDs unless directed to by your doctor.

For people with normal kidney function, avoid taking NSAIDs for more than 10 consecutive days for pain or 3 consecutive days for fever. Additionally, take the lowest dose that effectively manages your pain symptoms to avoid excessive drug exposure.

How do NSAIDs cause kidney damage?

NSAIDs can increase a person’s risk of sudden kidney failure or lead to progressive kidney damage when consumed in excessive doses or for extended periods. Long-term use can cause your body to retain fluids and prevent the kidneys from working properly.

How long does it take for NSAIDs to cause kidney damage?

It doesn’t take long for kidney damage to occur when taking NSAIDs. Research has shown that sometimes in just a week, acute kidney injury (AKI) can develop.

Factors that impact how quickly or severe the condition becomes include the dosage and frequency of use. However, studies have shown that if AKI is diagnosed early and NSAIDs are quickly identified as the cause, stopping NSAID use and beginning treatment can reverse the condition, and renal function can return to normal.

Is kidney damage caused by NSAIDs reversible?

Depending on the duration of NSAID usage, kidney damage can be reversed. However, previous kidney function, as well as factors such as hydration levels, can all influence renal function recovery.

What are the signs of kidney damage from pain meds?

Kidney damage caused by consuming pain medications is known as analgesic nephropathy. While many symptoms are associated with the condition, some people may be asymptomatic. Common symptoms include:

Regardless of whether you have a diagnosed kidney disorder or have healthy kidney function, OTC medications should be used with care. Excessive use by consuming too high a dose or for prolonged periods can lead to a variety of health problems throughout your body — including damage to the kidneys.

For people with kidney disease or impaired kidney function, avoiding NSAIDs unless directed by a physician is the safest way to avoid further harm. Instead, opt for acetaminophen and be sure to use the lowest dose for the shortest period to control pain symptoms.

And when in doubt, speak with a physician or health professional before taking an OTC pain medication.