Table 4 Drugs with renally eliminated active or toxic metabolites that may accumulate in AKI
From: Clinical review: Drug metabolism and nonrenal clearance in acute kidney injury
Drug | Drug class | Accumulated substance | Clinical consequence of metabolite accumulation |
|---|---|---|---|
Allopurinol | Xanthine oxidase inhibitor | Active metabolite oxypurinol | Increased risk for immune-mediated hypersensitivity reaction |
Codeine | Opioid analgesic | Active metabolites norcodeine and morphine | CNS depression, respiratory depression |
Dolasetron | Antiemetic | Active metabolite hydrodolasetron | Q-T prolongation/ECG changes |
Meperidine | Opioid analgesic | Toxic metabolite normeperidine | Anxiety, agitation, tremors, twitches, myoclonus, seizure |
Midazolam | Benzodiazepine | Active metabolites 1-hydroxymidazolam and 1-hydroxymidazolamglucuronide | Apnea, sedation, drowsiness |
Morphine | Opioid analgesic | Active metabolite morphine-6-glucuronide | CNS depression, respiratory depression |
Mycophenolate mofetil/mycophenolic acid | Immunosuppressant | Inactive glucuronide metabolite displacing mycophenolic acid from albumin and resulting in increased free mycophenolic acid concentration | Leukopenia |
Procainamide | Anti-arrhythmic | Active metabolite N-acetyl procainamide (NAPA) | Sinus bradycardia, sinus node arrest, Q-T interval prolongation |
Propoxyphene | Opioid analgesic | Active metabolite norpropoxyphene | Cardiotoxicity resulting in dysrhythmias |
Quinidine | Anti-arrhythmic, antimalarial | Active metabolite 3-hydroxy quinidine | Additive Q-T interval prolongation |
Voriconazole – intravenous formulation | Antifungal | Vehicle sulfobutyl ether β-cyclodextran sodium (SBECD) | Demonstrated proximal tubule toxicity in rats |