FSGS-Safe Over-the-Counter Medications — and Which to Avoid
Published on June 10, 2026
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When you have focal segmental glomerulosclerosis (FSGS), certain ingredients in medications, including over-the-counter (OTC) products, can build up in the bloodstream, increasing the risk of stronger side effects and further kidney problems.
This is because FSGS causes scarring in some of the tiny filters in the kidneys. When these filters are scarred, the kidneys can’t effectively remove waste and excess fluid from the body.
Some OTC medications can raise blood pressure, worsen proteinuria (excess protein in the urine), and affect the body’s ability to balance minerals like sodium and potassium, says Stephanie Diaz, MD, a board-certified nephrologist and a member of the teaching faculty at the University of Texas at Tyler in Tyler, Texas. All of these effects can place extra stress on the kidneys and worsen kidney damage.
While some OTC medications and ingredients are generally considered safe for people with FSGS, it’s important to read drug labels for hidden ingredients. Always check with your nephrology team before taking any new medications.
What to Look for on the Label
When reading OTC medication labels, here are a few drug facts and considerations to pay attention to:
- Active Ingredients The active ingredients are the substances that treat your symptoms. Always read this section to understand what’s in the product, says Jennifer Gershman, PharmD, a pharmacist based in Florida and part of the Everyday Health Expert Network. Active ingredients generally not recommended for people with FSGS include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve), which can cause further kidney damage, says Dr. Diaz. Oral decongestants like pseudoephedrine and phenylephrine, as well as products containing magnesium, aluminum, potassium, phosphorus, and sodium, can also increase blood pressure and affect the kidneys, and they should be avoided, she says.
- Warning Label This section explains who may need to avoid a medication or use it carefully due to possible side effects or health risks. “Look for kidney safety warnings on the label,” says Diaz.
- Directions This section tells you how much to take and how often. Taking more than the recommended dose or using a medication longer than directed can increase the risk of side effects and kidney problems.
- Combination Products Many cold, flu, and allergy medications contain more than one active ingredient. When possible, choose products with only one active ingredient instead of multisymptom formulas, says HaVy Ngo-Hamilton, PharmD, a pharmacist based in Portland, Maine, and senior pharmacy director at prescription discount service BuzzRx. Combination products can make it easier to accidentally take too much of an ingredient or take something that may not be safe for your kidneys.
- Your Avoid List Keep a list of ingredients that your nephrology care team has told you to avoid or use cautiously. Bring it with you when shopping for OTC medications, and if you’re unsure whether a product is safe, ask the pharmacist before buying it, Gershman says.
If your kidney function declines, some medications — even those that are safe to use for people with FSGS — can remain in the body longer, rather than being cleared normally by the kidneys.Your care team may recommend lower doses or less frequent use of these medications, depending on your current kidney function.
Pain Medications
NSAIDs, a class of pain medications commonly available OTC, can reduce blood flow to the kidneys, says Ngo-Hamilton. With FSGS, reduced blood flow can trigger the kidneys to raise blood pressure, contributing to added stress on already scarred kidney filters and causing further damage.
The risk of damage is higher with long-term use or higher doses of NSAIDs, such as over 4,000 milligrams (mg) of ibuprofen daily or over 3,200 mg of naproxen daily, says Ngo-Hamilton. Combining NSAIDs with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, which are blood pressure medications commonly prescribed for FSGS to help lower protein in the urine and slow kidney disease progression, can also increase the risk of kidney damage, she says.
Safe to Use
Acetaminophen (Tylenol) is generally the preferred OTC option for pain relief in people with chronic kidney disease such as FSGS, says Gershman. “But it’s a good idea to get the okay from your prescriber to make sure you don’t have liver problems, since acetaminophen is mainly broken down in the liver instead of the kidneys,” she says.
While the maximum daily dose of acetaminophen is 4,000 mg, Ngo-Hamilton says that experts recommend keeping your daily dose at or below 3,000 mg to reduce the risk of liver problems.
Avoid
Oral NSAIDs, which are generally not recommended if you have FSGS, include:
- ibuprofen
- naproxen
- high-dose aspirin (more than 325 mg per day)
That being said, low-dose aspirin for heart protection, from 81 to 100 mg per day, is generally safe and should be discussed with a physician, says Diaz.
Ask Your Doctor First
Topical NSAIDs like diclofenac gel (Voltaren) are applied to the skin and may be a safer alternative because less medication enters the bloodstream than with oral NSAIDs, says Ngo-Hamilton. Still, they’re not completely risk-free, so check with your nephrologist before using them, she says.
Cold, Flu, and Allergy Medications
OTC cold and flu medications may contain several active ingredients in one formula, some of which may not be safe for people with FSGS. For example, oral decongestants like pseudoephedrine and phenylephrine can raise blood pressure and affect the kidneys. Some combination medications also contain NSAIDs, which can further damage the kidneys.
Safe to Use
Safer OTC cold, flu, and allergy medications, according to Gershman and Ngo-Hamilton, include:
- dextromethorphan (such as Delsym)
- guaifenesin (such as Mucinex)
- loratadine (such as such as Claritin)
- cetirizine (such as Zyrtec)
- fexofenadine (such as Allegra)
For nasal congestion, saline nasal sprays, which are available OTC, are a good option because they usually contain no medication and don’t affect the kidneys or blood pressure, says Ngo-Hamilton.
For fever and body aches, acetaminophen remains the safer OTC option, but check labels carefully because acetaminophen is found in many cold and flu combination products.Taking more than one product with acetaminophen can increase the risk of liver problems, especially if you exceed the recommended daily dose, Ngo-Hamilton says.
Some of these medications may require dose adjustments depending on your kidney function. This is one reason why it’s important to check with your nephrologist or pharmacist before starting any new medication.
Avoid
Oral decongestants to avoid, Diaz says, include:
- pseudoephedrine (Sudafed)
- phenylephrine (Sudafed PE)
You should also avoid combination cold and flu medications that contain these oral decongestants, Diaz says. These include:
- DayQuil Cold & Flu
- Theraflu Daytime Severe Cold and Cough
If you take an antihistamine for allergies, stick to the plain formula. Products with a D in the name, such as Allegra-D, Claritin-D, and Zyrtec-D, contain an oral decongestant and should be avoided.
Ngo-Hamilton recommends avoiding combination cold and flu medications that contain NSAIDs, such as:
- Advil Cold and Sinus
- Advil Multi-Symptom Cold and Flu
- Sudafed Sinus 12-Hour Pressure + Pain
Ask Your Doctor First
Diphenhydramine (Benadryl) is generally safe for most people with FSGS but should be used with caution, says Diaz, because it can cause urinary retention (the inability to completely empty your bladder) and prolonged drowsiness in people with more advanced chronic kidney disease. Ask your nephrologist whether it’s appropriate before using it.
Antacids
Ngo-Hamilton and Gershman say that some OTC antacids and acid reducers are generally safe to use on a short-term basis when you have FSGS.
But products containing minerals like aluminum, magnesium, and sodium should generally be avoided, says Ngo-Hamilton. With scarred kidney filters, these minerals can accumulate in the bloodstream, leading to serious effects, including bone disease, fluid retention, high blood pressure, and heart rhythm issues.
Safe to Use
Even antacids and acid reducers that are considered safer choices for people with FSGS can cause problems when used for a long time. Always check with your nephrologist before starting any of them, and use the lowest effective dose for the shortest time needed.
- Calcium carbonate (Tums or Rolaids) helps neutralize acid in the stomach and is generally safe for occasional use to treat heartburn, says Gershman, but stick to the lowest dose needed, and avoid long-term use (longer than two weeks).
- H2 blockers like famotidine (Pepcid) and cimetidine (Tagamet) help reduce the amount of acid your stomach produces. They’re generally considered a kidney-friendly option for managing acid reflux, says Ngo-Hamilton. But avoid using these medications for longer than two weeks or at doses higher than recommended on the label, as this can increase the risk of side effects like confusion, liver problems, and muscle and joint pain.
Avoid
Gershman and Ngo-Hamilton recommend avoiding the following antacids that contain aluminum or magnesium:
- Mylanta
- Maalox
- Milk of Magnesia
- Gaviscon
Also consider avoiding sodium bicarbonate-based antacids such as Alka-Seltzer Original and Alka-Seltzer Extra Strength, because they may raise blood pressure and worsen fluid retention in people with FSGS. Some Alka-Seltzer products contain aspirin, which is one reason to always read the drug facts on the label before buying OTC medications.
Ask Your Doctor First
Proton pump inhibitors (PPIs) such as omeprazole (Prilosec) and lansoprazole (Prevacid) reduce stomach acid. When used for short periods, such as two to four weeks, these medications are usually not linked to kidney problems. But using them for longer than that (many months or years) can increase the risk of kidney inflammation and worsening kidney function, says Diaz.
Before taking a PPI, check with your nephrologist to understand if this class of medication is appropriate and how long to use it.
Antidiarrheals
Similar to antacids, the main concern with using certain OTC antidiarrheals when you have FSGS is avoiding ingredients that can accumulate in the body or place added stress on the kidneys, says Gershman.
Safe to Use
For short-term, acute diarrhea, loperamide (Imodium A-D) is generally considered safe for many people with FSGS when used as directed, says Ngo-Hamilton.
Avoid
Gershman recommends avoiding bismuth subsalicylate (Pepto-Bismol, Kaopectate). Salicylate, which is included in these medications, is an ingredient similar to aspirin that may worsen kidney function when you already have kidney disease.
Laxatives
Many OTC laxatives rely on minerals like magnesium or phosphorus to stimulate bowel movements. But in people with kidney disease, these minerals can accumulate in the body and increase the risk of dangerous electrolyte imbalances. Still, a few OTC laxatives are considered safe for people with FSGS.
Safe to Use
Safer OTC laxatives for people with FSGS, according to Gershman and Ngo-Hamilton, include:
- polyethylene glycol (MiraLAX)
- docusate (Colace)
- bisacodyl (Dulcolax)
Avoid
Gershman and Ngo-Hamilton recommend avoiding the following mineral-containing OTC laxatives:
- magnesium citrate (Citroma)
- magnesium hydroxide (Milk of Magnesia)
- sodium phosphate enema (Fleet Enema)
Excess magnesium levels in the body can cause weakness, low blood pressure, confusion, slowed breathing, and abnormal heart rhythms. Sodium phosphate products can cause serious electrolyte imbalances and, in some cases, permanent kidney damage.
Ask Your Doctor First
Fiber supplements such as psyllium (Metamucil) and methylcellulose (Citrucel) are generally considered safe if you have kidney disease, says Ngo-Hamilton, but they work best when taken with plenty of fluids. Always talk to your doctor before taking any supplements, especially if your nephrologist has put you on fluid restrictions or if you have significant swelling.
Vitamins and Supplements
Unlike prescription medications, dietary supplements aren’t approved by the FDA for safety or effectiveness, and their ingredients, strength, and purity can vary from product to product, says Ngo-Hamilton. Just because a supplement is labeled natural does not mean it’s safe for people with FSGS, Diaz says.
Some supplements can harm the kidneys, raise blood pressure, affect mineral levels, and interact with prescription medications, says Diaz.
Safe to Use
Guidelines recommend limiting herbal products and dietary supplements in people with chronic kidney disease. Your nephrologist may recommend specially formulated supplements that are usually available by prescription.
Before taking any OTC vitamins, supplements, or herbal products, check with your nephrology care team first.
Avoid
Unless your nephrologist gives you permission to take them, the supplements and herbal products below should be avoided because they can be harmful to your kidneys:
- High-dose vitamin C (which is more than 1,000 mg per day, says Ngo-Hamilton)
- Creatine
- Protein powders and high-protein supplements
- Potassium supplements and potassium-containing salt substitutes
- Supplements containing phosphorus
- Herbal products containing aristolochic acid
- Echinacea
- St. John’s wort
- Cat’s claw
- Nettle
- Licorice root
- Horsetail
- Aloe (taken by mouth)
- Yohimbe
- Barberry
- Oregon grape root
- Parsley root
- Astragalus
The Takeaway
- Many over-the-counter medications are safe to use with FSGS, but some can raise blood pressure, worsen proteinuria, and affect mineral balance. Always read the drug facts label to understand what’s in a product.
- Acetaminophen is considered the safest OTC option for pain and fever if you have FSGS. For cold, flu, and allergy symptoms, safer options include guaifenesin and loratadine, while decongestants like pseudoephedrine and phenylephrine should be avoided.
- Calcium carbonate, polyethylene glycol, and docusate are considered safer antacids, while products containing magnesium, aluminum, sodium phosphate, and large amounts of sodium can cause serious problems in people with FSGS.
- Even with safer OTC options, make it a habit to run all medications, vitamins, and supplements by your nephrology care team before taking any new medications.
Resources We Trust
- Cleveland Clinic: NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)
- Mayo Clinic: Pseudoephedrine (Oral Route) — Side Effects and Dosage
- National Kidney Foundation: Safe Medicine Use With Chronic Kidney Disease
- American Kidney Fund: Herbal Supplements and Chronic Kidney Disease
- U.S. Food and Drug Administration: The Over-the-Counter Drug Facts Label
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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