Which medications, including Bumex (bumetanide), Losartan Potassium, Percocet (oxycodone and acetaminophen), Trillix (trazodone), Mirtazapine, Simvastatin, and Dapagliflozin, may cause impaired renal function?

From the Guidelines

Patients taking Bumex, Losartan potassium, Percocet, Dapagliflozin, Simvastatin, Mirtazapine, and Trilipix should be closely monitored for kidney issues, as these medications can potentially cause kidney damage or exacerbate existing kidney disease, particularly in patients with pre-existing kidney conditions or those taking multiple medications that affect kidney function 1.

Medication-Specific Risks

• Bumex (bumetanide) is a loop diuretic that can cause dehydration and electrolyte imbalances, potentially stressing the kidneys 1.
• Losartan potassium can occasionally cause acute kidney injury, especially when starting treatment 1.
• Percocet contains oxycodone and acetaminophen; the acetaminophen component can cause kidney damage with long-term use or overdose 1.
• Dapagliflozin, an SGLT2 inhibitor for diabetes, has been associated with acute kidney injury, particularly when patients become dehydrated 1.
• Simvastatin rarely causes kidney problems but can lead to rhabdomyolysis (muscle breakdown) which can damage kidneys 1.
• Mirtazapine (an antidepressant) and Trilipix (fenofibric acid) generally have lower risks of direct kidney toxicity 1.

Recommendations

• Patients taking these medications should maintain adequate hydration, have regular kidney function monitoring, and immediately report symptoms like decreased urination, swelling, or unusual fatigue 1.
• Those with existing kidney disease should have dosages carefully adjusted by their healthcare provider, as many of these medications are processed through the kidneys and may require dose modifications 1.

Key Considerations

• Regular monitoring of kidney function is crucial for patients taking these medications, especially those with pre-existing kidney conditions 1.
• Healthcare providers should carefully weigh the benefits and risks of each medication and adjust dosages accordingly to minimize the risk of kidney damage 1.

From the FDA Drug Label

DAPAGLIFLOZIN TABLETS can cause some people to become dehydrated (the loss of body water and salt). Dehydration may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension) There have been reports of sudden kidney injury in people with Type 2 diabetes who are taking DAPAGLIFLOZIN TABLETS You may be at a higher risk of dehydration if you: ∘ take medicines to lower your blood pressure, including water pills (diuretics) ∘ are on a low salt diet ∘ have kidney problems ∘ are 65 years of age or older

The medications that may cause kidney issues are:

• Dapagliflozin: may cause dehydration and sudden kidney injury, especially in people with type 2 diabetes.
• Losartan potassium: as a blood pressure medication, it may increase the risk of dehydration when taken with dapagliflozin.
• Bumex: as a diuretic, it may increase the risk of dehydration when taken with dapagliflozin. The other medications listed (Percocet, Trillpix, Mirtazapine, Simvastatin) do not have a direct interaction with kidney issues based on the provided drug labels 2, 2, and 2.

From the Research

Medication and Kidney Issues

The medications listed, including bumex, losartan potassium, Percocet, Trillpix, mirtazapine, simvastatin, and dapagliflozin, may have varying effects on kidney function.

• Dapagliflozin has been shown to reduce the risk of kidney failure and heart failure in patients with chronic kidney disease, as demonstrated in the DAPA-CKD trial 3.
• The interaction between dapagliflozin and the loop diuretic bumetanide has been studied, and results suggest that there are no meaningful pharmacokinetic interactions between the two medications 4.
• Dapagliflozin has been found to be effective in reducing glycosylated haemoglobin, fasting plasma glucose levels, and body weight in patients with type 2 diabetes, with a low risk of hypoglycaemia 5.
• The current role of dapagliflozin in clinical practice includes its use in the management of type 2 diabetes, heart failure, and chronic kidney disease, with a good safety profile 6.
• A prespecified analysis from the DAPA-CKD trial found that dapagliflozin slowed the rate of decline in kidney function in patients with chronic kidney disease, with and without type 2 diabetes 7.

Key Findings

• Dapagliflozin reduces the risk of kidney failure and heart failure in patients with chronic kidney disease 3.
• Dapagliflozin has a low risk of hypoglycaemia and is generally well tolerated 5.
• The combination of dapagliflozin and bumetanide demonstrates mutual adaptive natriuretic synergy 4.
• Dapagliflozin slows the rate of decline in kidney function in patients with chronic kidney disease, with and without type 2 diabetes 7.

Medication Interactions

• The interaction between dapagliflozin and bumetanide has been studied, with results suggesting no meaningful pharmacokinetic interactions 4.
• Dapagliflozin can be used in combination with other medications, including loop diuretics, with careful monitoring of kidney function and electrolyte levels 4, 6.