CDSCO Advisory: Unregulated Painkiller Use, Antibiotic Misuse Pose Kidney Risks
The Central Drugs Standard Control Organisation (CDSCO) has issued a fresh advisory warning against the misuse of painkillers and antibiotics, highlighting the risk of kidney complications and antimicrobial resistance. The drug regulator has urged people not to take non-steroidal anti-inflammatory drugs (NSAIDs), commonly used as painkillers, repeatedly or for prolonged periods without medical advice.
The advisory, issued on Monday, also cautions against self-medication with antibiotics. It advises individuals with existing kidney disease or other risk factors for renal impairment to inform their doctor before taking NSAIDs. The CDSCO circular states that NSAIDs and antibiotics are prescription medicines under the Drugs and Cosmetics Rules and should be used only when clinically indicated, at the appropriate dose and duration, and under medical supervision.
Prof Sandeep Mahajan, nephrologist at AIIMS, said that unregulated and prolonged use of painkillers can accelerate the decline in kidney function, particularly in people with chronic kidney disease. "All prescription medicines should be taken under the supervision of a qualified physician, with the prescribed dose and duration strictly followed. Medicines from alternative systems should also be used with caution, as some may contain substances that can be toxic to the kidneys," he said.
Dr Dinesh Khullar, Group Chairman, Nephrology & Renal Transplant Medicine, Max Super Speciality Hospital, Saket, added, "Misuse of non-steroidal anti-inflammatory drugs can cause serious kidney injury, particularly in people with pre-existing kidney disease. Even short-term use can be risky in vulnerable individuals. People should therefore avoid unnecessary self-medication and take these medicines only on medical advice."
The warning comes amid a substantial chronic kidney disease (CKD) burden in India. A 2025 systematic review of community-based studies estimated the pooled CKD prevalence at 13.24%, although estimates varied widely across regions and studies. The CDSCO has advised doctors to use the lowest effective dose of NSAIDs for the shortest appropriate duration, with extra caution in patients at risk of kidney injury.
On antibiotics, the regulator has urged judicious use, avoiding unnecessary combinations, incorrect dosing, and prolonged treatment. The National Centre for Disease Control's (NCDC) 2024 surveillance across 66 tertiary-care institutions found excessive consumption of "Watch" antibiotics, which have a higher resistance potential, along with inadequate use of "Access" antibiotics recommended as first-line treatment. The report also flagged inconsistent implementation of antimicrobial stewardship programmes.
Self-medication remains common in India, with analgesics, antipyretics, and antibiotics among the frequently self-medicated drugs. Pharmacists and retailers have been asked to enforce prescription rules, while hospitals and state regulators have been told to strengthen oversight and awareness of the risks, including kidney complications and antimicrobial resistance.
NSAIDs work by blocking certain chemicals in the body that cause pain and inflammation. However, they can also reduce blood flow to the kidneys, potentially leading to acute kidney injury, especially in people who are dehydrated or have pre-existing kidney conditions. Prolonged use without medical supervision can worsen kidney function over time.
Antibiotic misuse, on the other hand, fuels antimicrobial resistance (AMR), a growing global health threat. When antibiotics are taken unnecessarily or incorrectly, bacteria evolve to become resistant, rendering these medicines ineffective. The NCDC report highlighted that "Watch" antibiotics, which are more prone to resistance, were being overused, while "Access" antibiotics, which should be first-line treatments, were underused.
The CDSCO has also called upon healthcare professionals to educate patients about the safe use of these medicines and to prescribe them only when necessary. It reiterated that the benefits of NSAIDs and antibiotics should be weighed against their potential risks.
Health experts emphasise that rational use of medicines is crucial to prevent avoidable harm. The CDSCO's advisory serves as a reminder that painkillers and antibiotics are not without risks and should be used responsibly under medical guidance.
