Do quetiapine (Seroquel), sertraline (Zoloft), clonazepam, or buspirone (Buspar) affect kidney function or increase the risk of kidney stones in a patient developing nephrolithiasis?

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Last updated: September 21, 2026 • View editorial policy

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Direct Answer to Your Question

None of these four medications—Seroquel (quetiapine), Zoloft (sertraline), clonazepam, or Buspar (buspirone)—directly cause kidney stones, but quetiapine carries the highest risk for kidney injury overall and warrants the most caution in your patient.

Kidney Stone Risk Assessment

No Direct Stone Formation Risk

The 2026 pharmacovigilance study analyzing FDA adverse event reports identified 50 drugs most frequently associated with nephrolithiasis 1. Notably, none of your patient's medications (quetiapine, sertraline, clonazepam, or buspirone) appeared on this list. The drugs with strongest signals for stone formation were antiretrovirals (particularly indinavir), adalimumab, and certain antibiotics—not psychiatric medications.

Kidney Function Concerns by Medication

Quetiapine (Seroquel) - HIGHEST RISK

Quetiapine poses the greatest risk to kidney function among these four medications 2:

  • Meta-analysis showed atypical antipsychotics increase overall renal impairment risk (RR 1.34,95% CI 1.23-1.47)
  • Quetiapine specifically carries the highest risk for both acute kidney injury (RR 1.51) and chronic kidney disease (RR 1.23) among atypical antipsychotics 2
  • In older adults, quetiapine use increased AKI hospitalization risk by 73% (RR 1.73) 3
  • The mechanism involves hypotension, acute urinary retention, and potential rhabdomyolysis—all of which can precipitate AKI 3

Clinical implication: Monitor kidney function more closely if continuing quetiapine, especially if your patient develops dehydration or other AKI risk factors.

Sertraline (Zoloft) - MINIMAL RISK

Sertraline does not affect kidney function or require dose adjustment in renal impairment 4:

  • FDA labeling explicitly states: "No dose adjustment is needed in patients with mild to severe renal impairment"
  • "Sertraline exposure does not appear to be affected by renal impairment" 4
  • The 2022 systematic review found antidepressants were not associated with acute or chronic kidney harms 5

Clinical implication: Safe to continue without kidney-related concerns.

Buspirone (Buspar) - LOW RISK

Buspirone shows minimal kidney effects but accumulates slightly in severe renal failure 6:

  • FDA labeling notes buspirone is "metabolized by the liver and excreted by the kidneys" 6
  • In mild-to-moderate renal impairment, pharmacokinetics remain similar to normal function 7
  • Only in anuric patients does the active metabolite (1-PP) accumulate, with AUC increasing 4-fold 6
  • A 25-50% dose reduction is suggested only for anuric patients 7

Clinical implication: No adjustment needed for early kidney stone disease; only relevant in advanced renal failure.

Clonazepam - MINIMAL RISK

No evidence exists linking benzodiazepines to kidney dysfunction:

  • The 2022 systematic review specifically noted: "No studies examining kidney adverse effects of other psychotropes, such as benzodiazepines, met inclusion criteria" 5
  • Benzodiazepines are primarily hepatically metabolized with minimal renal impact

Clinical implication: Safe to continue without kidney-related concerns.

Practical Management Algorithm

For your patient developing kidney stones:

  1. Continue Zoloft, clonazepam, and Buspar without modification - these pose negligible kidney risk

  2. Exercise heightened vigilance with Seroquel:

    • Monitor for dehydration (quetiapine can cause hypotension)
    • Watch for urinary retention symptoms
    • Consider baseline and periodic creatinine monitoring
    • If AKI develops, quetiapine may be a contributing factor

  3. Focus on actual stone prevention per EAU guidelines 8:

    • Identify stone composition and metabolic risk factors
    • Implement dietary modifications
    • Ensure adequate hydration (especially important given quetiapine's hypotensive effects)
    • Consider metabolic evaluation if recurrent stones develop

Critical Caveat

The kidney injury risk from quetiapine is indirect (via hypotension, urinary retention, rhabdomyolysis) rather than direct nephrotoxicity 3. This means maintaining adequate hydration and monitoring for these complications is more important than stopping the medication outright, especially if it's providing psychiatric benefit. The absolute risk increase for AKI with quetiapine in older adults was only 2.12% 3, so this is a risk to monitor rather than an absolute contraindication.

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.