Kidney disease, prostate cancer, and OTC products

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The culprits Omeprazole and other PPIs. With the recent introduction of OTC esomeprazole magnesium (Nexium—P zer), three distinct proton pump inhibitor (PPI) medications and various generics are now available without a prescription. Many patients have positive outcomes with these medications without a physician appointment. However, there are risks to consider, and kidney disease is one that has been recently reported. A recent retrospective analysis of 133 cases of acute interstitial nephritis (AIN) found drugs to be the leading culprit in 70% of cases, and of those, omeprazole (Prilosec—AstraZeneca) was the causative agent in 12% of patients. Patients using omeprazole were older and had better baseline renal function and a longer duration of PPI use compared with cases of AIN not related to drug therapy.1 Similar data were found in a case control study in New Zealand.2 What does this mean in the self-care environment? Take advantage of opportunities to talk with patients about the appropriate way to use an OTC PPI, and discuss potential adverse reactions, including back pain, fever, blood in the urine, decreased urine output, and weight gain. NSAIDs. A number of studies have been published recently that discuss NSAID use in patients with kidney disease. In one study of 185 patients with chronic kidney disease, the authors determined how many took what was considered an inappropriate medication based on dosing recommendations in the package insert, which in turn were based on calculated creatinine clearance. More than 80% of those surveyed used at least one inappropriate medication, and of those, 66% were using an NSAID.3 When counseling patients on NSAID use, be sure to verify that the patient doesn’t have any type of renal dysfunction. Also, when dispensing medications that are commonly prescribed to patients with renal disease, counsel about the risks of using an OTC NSAID.