Expert Q&A: Safe OA Medications for Kidney Health

Question: My question concerns arthritis and kidney health. I have osteoarthritis (OA), but I cannot take many medications because I have kidney problems. Is there any treatment I could try that would not affect my kidneys?  

Answer: For patients with many types of arthritis, kidney problems can indeed complicate treatment plans. If you have diminished kidney function, you may need to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn), but there are many other options for arthritis and kidney patients. The first option is acetaminophen (Tylenol), which is an analgesic, not an NSAID. 

Injections of hyaluronic acid compounds, which are designed to supplement a substance that gives joint fluid its viscosity, for example, may provide relief in affected joints (usually knees) without involving the kidneys. These products include Hyalgan, OrthoVisc, Supartz and Synvisc. 

There are also topical products for arthritis that affects only one or two joints. A gel form of the prescription NSAID diclofenac (Voltaren Gel) is one option. Only a very small amount of the drug gets into the bloodstream, so it may be safe for your kidneys.  However, topicals may not work well for hip pain, because the joint is too deep for the medication to penetrate. 

The most effective of the over-the-counter products are those containing capsaicin (Capzasin, Salonpas Hot and Zostrix). Derived from hot chili peppers, capsaicin has been found to reduce a chemical in the body that transmits pain signals. 

Other nonprescription topicals include: 

• Counterirritants, which include ingredients such as menthol and camphor (Biofreeze and JointFlex). These provide a mild cooling sensation that distracts from underlying pain. 
• Salicylates, which are related to aspirin and relieve pain directly, include products such as Aspercreme and Myoflex. 
• Combination products may contain ingredients such as methyl salicylate and menthol (mentholatum cream, BenGay), or capsaicin, salicylates and a counterirritant (Heet  liniment). 

Of course, there are several nondrug treatments, too, that would be completely safe for your kidneys. These include using a brace or cane, using heat and cold therapy, taping a joint, going to physical therapy and trying acupuncture. 

Don Miller, PharmD
Professor, Department of Pharmacy Practice 
North Dakota State University
Fargo, North Dakota