Kidney damage“Long-term chronic use of painkillers can lead on to significant kidney damage,” Mahajan said, referring to the condition as analgesic nephropathy.
Besides directly causing kidney damage, they can accelerate the decline in kidney function among patients who already have impaired kidney function.
They can also amplify kidney damage caused by other conditions or substances that are toxic to the kidneys.
Their inhibition can reduce renal blood flow and trigger acute kidney injury, particularly during dehydration, certain infections and in people with pre-existing kidney disease, she said.
Certain antibiotics can also cause kidney injury depending on the drug, dose, duration and individual patient factors.
Nephrologists are seeing patients with kidney dysfunction who have a history of frequent or unsupervised use of painkillers, with doctors warning that repeated use of commonly available medicines can cause acute kidney injury and, in some cases, contribute to long-term kidney damage.
The observations come after the Central Drugs Standard Control Organisation (CDSCO) issued an advisory on September 22 cautioning against the indiscriminate use of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics and highlighting the associated risk of chronic kidney disease.
According to Sandeep Mahajan, professor, Nephrology department at AIIMS Delhi, painkiller use could have a primary or secondary association with kidney disease in around 10-15 per cent of patients he sees. He described a primary association as the drug itself causing damage and a secondary association as the medicine worsening damage caused by another condition.
Kidney damage
“Long-term chronic use of painkillers can lead on to significant kidney damage,” Mahajan said, referring to the condition as analgesic nephropathy.
According to him, painkillers can affect the kidneys in several ways. Besides directly causing kidney damage, they can accelerate the decline in kidney function among patients who already have impaired kidney function. They can also amplify kidney damage caused by other conditions or substances that are toxic to the kidneys.
Doctors said the risk is particularly relevant because many patients consider commonly available painkillers to be harmless.
According to Soubeer Ghosh, Consultant Nephrologist and Kidney Transplant Physician, PSRI Hospital, New Delhi, NSAIDs such as ibuprofen, diclofenac and naproxen can affect kidney function when taken frequently, at high doses or without medical supervision. They can reduce blood flow to the kidneys, making it harder for them to filter waste effectively.
“A single short course may not cause a problem in a healthy person, but repeated or prolonged use, especially in people who already have diabetes, hypertension or kidney disease, can increase the risk of acute kidney injury and, over time, contribute to chronic kidney damage,” he added.
Self-medication
He said the more worrying trend in clinical practice was self-medication, with some patients repeating an old prescription whenever similar symptoms recurred, without checking whether the medicine remains appropriate or whether their kidney function has changed.
Lovy Gaur, Senior Consultant, Nephrology, Medanta Noida, said NSAIDs including ibuprofen, diclofenac, naproxen and aceclofenac can affect kidney function, particularly when repeatedly used in high doses or without supervision.
These medicines reduce the production of prostaglandins, which help maintain blood flow to the kidneys. Their inhibition can reduce renal blood flow and trigger acute kidney injury, particularly during dehydration, certain infections and in people with pre-existing kidney disease, she said.
“Painkiller-related kidney injury is a recognised clinical concern,” Gaur said, adding that patients who receive repeated doses or combine multiple painkillers could be at greater risk.
Who is at higher risk
The doctors said older adults and people with pre-existing kidney disease, diabetes, hypertension, heart failure or dehydration are particularly vulnerable to kidney-related complications.
Ghosh said patients who are dehydrated because of vomiting, diarrhoea, fever or inadequate fluid intake could be at higher risk. The risk can also increase when multiple medicines are taken together.
Gaur said patients taking diuretics, ACE inhibitors or angiotensin receptor blockers may face an increased risk when NSAIDs are used, particularly during illness or dehydration. Certain antibiotics can also cause kidney injury depending on the drug, dose, duration and individual patient factors.
Gaur added that an increase in kidney disease cannot automatically be attributed to painkillers and antibiotics based on patient volumes alone.
Awareness required
The nephrologists said the CDSCO advisory is an important step, but its impact will depend on implementation and awareness among patients, doctors and pharmacists.
“Public awareness is also very important,” Mahajan said, adding that the advisory could help make information about the risks more widely available.
Ghosh said people often assume that medicines available without a prescription are relatively harmless. “Over-the-counter availability does not remove the potential side effects of a medicine,” he said.
Published on September 23, 2026
