Enlist which drugs are nephrotoxic from this list

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Here is a clear breakdown of the drugs from your Dialysis Crash Cart list that are nephrotoxic, grouped by risk level:

Nephrotoxic Drugs from the List

HIGH Nephrotoxicity Risk

#	Drug	Mechanism of Nephrotoxicity
xvi	Inj. Vancomycin HCl 500 mg	Direct tubular toxicity; risk increases significantly when trough levels >20 mcg/mL. Risk amplified when combined with other nephrotoxins. Well-established nephrotoxin.
vii	Inj. Theophylline / Etophylline	Can cause renal vasoconstriction; toxic levels cause ischemic renal injury. Renally cleared - accumulates in renal failure.

MODERATE Nephrotoxicity Risk (Indirect / Dose-dependent)

#	Drug	Mechanism
xiii	Inj. Furosemide (Lasix) 10 mg/2 mL	Loop diuretic - causes volume depletion leading to prerenal AKI if over-used. Also potentiates nephrotoxicity of vancomycin and aminoglycosides when combined.
x	Inj. Tranexamic Acid 500 mg/5 mL	Can cause renal cortical necrosis at high doses (rare but documented); caution in pre-existing renal impairment.
iii	Inj. Iron Sucrose 100 mg/5 mL	Intravenous iron can generate free radicals causing oxidative tubular injury, particularly in AKI patients. Studies have shown iron sucrose causes tubular cell apoptosis.
xxv	Inj. Magnesium Sulphate 500 mg/2 mL	Magnesium is renally excreted; in renal failure it accumulates to toxic levels. Not a nephrotoxin itself, but dangerous in existing renal compromise (dialysis patients).
xvii	Inj. Sodium Bicarbonate 7.5%/10 mL	Alkalosis from over-correction can impair renal autoregulation; generally safe but requires careful titration in dialysis patients.

LOW / CONTEXT-DEPENDENT Risk

#	Drug	Note
xxvii	Tab. Aspirin 75 mg (gastro-resistant)	NSAIDs/aspirin inhibit prostaglandin-mediated renal afferent arteriolar dilation - can precipitate AKI in hypovolemic or low-flow states. At 75 mg dose, risk is low but present.
ix	Inj. Phenytoin Sodium 50 mg/2 mL	Propylene glycol vehicle in IV formulation is nephrotoxic in large/cumulative doses. Phenytoin itself can cause interstitial nephritis.

Drugs on the List That Are NOT Significantly Nephrotoxic

Vit B12, Emset (Ondansetron), Pantoprazole, Labetalol, Tramadol, Ranitidine, PCM, Dexamethasone, Pheniramine, Hydrocortisone, Aminophylline, Nitroglycerin, Mephentine, Glycopyrrolate, Dobutamine, Amiodarone, Noradrenaline, Metoprolol, Isosorbide dinitrate, Nifedipine (Depin), Diazepam, Midazolam, Lignocaine gel - these are renally cleared (meaning impaired renal function affects their dosing) but are not direct nephrotoxins.

Key Clinical Pearl for a Dialysis Unit

The most dangerous combination on this list is Vancomycin + Furosemide - furosemide-induced volume depletion dramatically raises vancomycin nephrotoxicity risk. This combination should be closely monitored with vancomycin AUC/MIC-based dosing rather than trough-only monitoring.

Sources: Goodman & Gilman's Pharmacological Basis of Therapeutics; Harrison's Principles of Internal Medicine 22E; Comprehensive Clinical Nephrology 7th Ed; Katzung's Basic & Clinical Pharmacology 16th Ed.

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