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263 - Dosing Information in Renal Impairment PDF
263 - Dosing Information in Renal Impairment PDF
No. Drug name Usual dose Adjustment for Renal failure estimated HD , CAPD
CrCl (ml/min)
Aminoglycoside antibiotics
1 Amikacin 7.5 mg /kg q 12 hr > 50-90 7.5 mg/kg q 12 hr HD: ½ of normal renal function dose AD
10-50 7.5 mg/kg q 24 hr
< 10 7.5 mg/kg q 48 hr CAPD : 15-20 mg lost per L dialysate
15 mg per kg Once Daily > 80 15 mg/kg/day per day
60-80 12 mg/kg/day
40-60 7.5 mg/kg/day
30-40 4 mg/kg/day
20-30 7.5 mg/kg q 48 hr
10-20 4 mg/kg q 48 hr
< 10 3 mg/kg q 72 hr and AD
2 Gentamicin 1.7 mg/kg q 8 hr > 50-90 100% q 8 hr HD: ½ of normal renal function dose AD
10-50 100% q 12 - 24 hr CAPD: 3-4 mg lost per L dialysate
< 10 100% 48 hr per day
5.1 mg per kg Once Daily > 80 5.1 mg/kg/day , 60-80 4 mg/kg/day
40-60 3.5 mg/kg/day , 30-40 2.5
mg/kg/day
20-30 4 mg/kg q 48 hr,10-20 3mg/kg q 48
hr
< 10 2 mg/kg q 72 hr and AD
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Dosing information in renal impairment
3 Streptomycin sulfate 15 mg/kg (max. of 1.0 g) q > 50-90 15 mg/kg q 24 hr HD: ½ of normal renal function
24 hr 10-50 15 mg/kg q 24-72 hr dose AD
< 10 15 mg/kg q 72-96 hr CAPD: 20-40 mg lost per L
15 mg per kg once daily > 80 15 mg/kg/day dialysate per day
60-80 12 mg/kg/day
40-60 7.5 mg/kg/day
30-40 4 mg/kg/day
20-30 7.5 mg/kg q 48 hr
10-20 4 mg/kg q 48 hr
< 10 3 mg/kg q 72 hr and AD
4 Kanamycin 5 - 7.5 mg/ kg 8 - 12 hr 50 - 80 100% q 12 hr HD: Extra 50% of normal renal
60 - 90% q 8 - 12 hr Function dose AD
10-50 30 - 70% q 12 hr CAPD: 15-20 mg lost per L of
< 10 20 - 30% q 24 - 48 hr Dialysate per day
15 mg per kg once daily > 80 15 mg/kg/day
60-80 12 mg/kg/day
40-60 7.5 mg/kg/day
30-40 4 mg/kg/day
20-30 7.5 mg/kg q 48 hr
10-20 4 mg/kg q 48 hr
< 10 3 mg/kg q 72 hr or AD
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Dosing information in renal impairment
5 Netilmicin 2 mg/kg q 8 hr > 50-90 100% normal dose q 8 hr HD: Extra 50% of normal renal
10-50 100% normal dose q 12-24 hr function dose AD
< 10 100% normal dose q 48 hr CAPD: 3-4 mg lost per L dialysate
Once Daily Dosing >80 6.5 mg/kg q 24 hr per day
60-80 5 mg/kg q 24 hr
40-60 4 mg/kg q 24 hr
30-40 2 mg/kg q 24 hr
20-30 3 mg/kg q 48 hr
10-20 2.5 mg/kg q 48 hr
<10- 0 2 mg/kg q 72 hr and AD
Carbapenem antibiotics
6 Imipenem 0.5 g q 6 hr > 50-90 250 - 500 mg q 6 - 8 hr HD: Dose AD (refer to timing of dose)
10-50 250 mg q 6 - 12 hr CAPD: Dose for CrCl < 10
Dose for CRRT: 0.5-1 gm bid
< 10 125 - 250 mg q 12 hr
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Dosing information in renal impairment
Cephalosporin Antibiotics
10 Cefazolin Sodium 1 - 2 g q 8 hr > 50-90 1.0-2.0 g q 8 hr HD: 0.5-1 g AD
10-50 1.0-2.0 g q 12 hr CAPD: 0.5 g q 12 hr
< 10 1.0-2.0 g q 24-48 hr
11 Cefotaxime 2 g q 8 hr > 50-90 2 g q 8-12 hr HD: Extra 1 g AD
10-50 2 g q 12-24 hr CAPD: 0.5-1 g q 24 hr
< 10 2 g q 24 hr
12 Cefoxitin 2 g q 8 hr > 50-90 2 g q 8 hr HD: Extra 1 g AD
10-50 2 g q 8-12 hr CAPD: 1 g q 24 hr
< 10 2 g q 24-48 hr
13 Ceftazidime 2 g q 8 hr > 50-90 2 g q 8-12 hr HD: Extra 1 g AD
10-50 2 g q 12-24 hr CAPD: 0.5 g q 24 hr
< 10 2 g q 24-48 hr
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Dosing information in renal impairment
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Dosing information in renal impairment
Fluoroquinolone Antibiotics
20 Ciprofloxacin inj. 400 mg q 12 hr or > 50-90 100% HD: 200 mg IV q 12 hr
10-50 400 mg IV q 24 hr CAPD: 200 mg IV q 8 hr
< 10 50%
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Dosing information in renal impairment
26 Levofloxacin 750 mg q 24 hr IV,PO > 50-90 750 mg q 24 hr HD/CAPD Dose for CrCl < 20
20-49 750 mg q 48 hr
<20 750 mg once, then 500 mg q 48 hr
Macrolide Antibiotics
27 Clarithromycin 0.5-1 g q 12 hr > 50-90 100% of normal dose HD: Normal Dose AD
10-50 75% of normal dose CAPD: none
< 10 50-75% of normal dose
28 Erythromycin 250-500 mg q 6 hr > 50-90 100% HD: Dose AD
10-50 100% CAPD: none
< 10 50-75%
Miscellaneous Antibacterial Antibiotics
29 Colistin 2.5 E 5 mg /kg/day > 80-100 100-150 mg q8-12 hr (300 mg/day) HD: 80 mg AD
(Colistimethate Sodium) Divided 2 - 4 doses/day 40-70 75-115 mg q 12 hr
150 mg colistin base/vial 25-40 66-150 mg q 12 -24 hr
10-25 100-150 mg q 36 hr
30 Cotrimoxazole Non-PJP: 1 DS >30 Usual dose HD: Avoid if possible.
(Tablet: TMP 80 mg/ Tablet every 12 hr < 15 Administer 50% of recommend dose If unavoidable, give 50% of
SMZ 400 mg ) PJP prophylaxis: < 15 Not recommended Maintenance dose q 24 hr on
one DS tablet daily dialysis day dose AD
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Dosing information in renal impairment
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Dosing information in renal impairment
10-50 q 6-12 hr
< 10 q 12-24 hr
36 Clindamycin (oral form) 150-450 mg q 6 hr No adjustment in renal failure No adjustment
Penicillin Antibiotics
33 Amoxillin(AM) 500 mg/ 125 mg q 8 hr > 50-90 500/125 mg AM component q 8 hr HD: As for CrCl < 10
/ clavulanate 10-50 250-500 mg of AM component extra dose after dialysis
(oral form) q 12 hr
< 10 250-500 mg of AM component
q 24 hr
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Dosing information in renal impairment
41 Piperacillin(P)/Tazobactam(T) 3.375-4.5 gm q 6-8 hr > 50-90 100% HD: Dose for CrCl<10 +0.75 gm AD
10-50 2.25 gm q 6 hr CAPD: 4.5 gm q 12 hr,
if CrCl< 20 q 8 hr same dose for CRRT CRRT: 4.5 gm q 48 hr
< 10 2.25 gm q 8 hr
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Dosing information in renal impairment
Tetracycline Antibiotics
42 Tetracycline 250 - 500 mg q 6-12 hr >50-90 q 8-12 hr HD/CAPD: None
10-50 q 12-24 hr
< 10 q 24 hr
43 Doxycycline 100 mg q 12 hr No adjustment in renal failure No adjustment
Antifungal antibiotics
44 Amphotericin B UVWXYPZRSกXYUก[\][^_KL`_ (Nephrotoxicity) aMbcdefZghXZP`_iก]YKLS
Non- lipid: 0.4-1 mg/ kg q 24 hr > 50-90 q 24 hr HD: No adjustment
ABLC: 5 mg/kg/day 10-50 q 24 hr CAPD: No adjustment
LAB: 3-5 mg/kg/day < 10 q 24 hr
45 Fluconazole 100 - 400 mg q 24 hr > 50-90 100% HD: 100% of recommended dose
10-50 50% AD
< 10 50% CAPD: Dose for CrCl < 10
46 1) Itraconazole, po soln 100-200 mg q 12 hr > 50-90 100% HD/CAPD :oral solution 100 mg q 12-
10-50 100% 24 hr
< 10 50%
2) Itraconazole, IV 200 mg IV q 12 hr > 50-90 200 mg IV bid
< 50 Do not use IV form if CrCl < 30
due to accumulation of carrier: cyclodextrin
47 Terbinafine 250 mg po per day > 50-90 q 24 hr
< 50 jZYQOkกUOklgSกXYamdaMbcdefZg
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Dosing information in renal impairment
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Dosing information in renal impairment
Antituberculous Antibiotics
52 Ethambutol 15-25 mg/kg q 24 hr ≥ 50-90 q 24 hr HD: Dose AD
10-50 q 24-36 hr CAPD: Dose for CrCl < 10
< 10 q 48 hr
53 Isoniazid (INH) 5 mg/kg q 24 hr No adjustment HD: Dose AD
(max 300 mg) CAPD: Dose for CrCl < 10
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Dosing information in renal impairment
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Dosing information in renal impairment
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Dosing information in renal impairment
< 10 25-50 mg q 24 hr
63 Nelfinavir 750 mg tid orally or 1250 bid Insufficient data
64 Nevirapine Initial : 200 mg OD x 14 days ≥ 20 No adjustment An additional 200 mg dose is
Maintenance: 200 mg bid recommended following HD
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Dosing information in renal impairment
Reference
1. jcKpqLกXYeYRirMX\gXaMbcdefZgsYj`_ SXMZ[mXกXYNOPUhtRmtMUnu กOoKpSXMUhtRmกYYp sYS]gXiXOQX\aQvK U\qLMUp^XgM 2552
2. Lacy CF, et al, Drug information Handbook 2009- 2010 18th ed Philadelphia Lexi- Comp Inc ; 2009
3. Gilbert DN , et al , The Sanford guide to antimicrobial therapy ,40 th ed , Antimicrobial Therapy, Inc, 2010
4. Micromedex Health Care Seires, (Electronic version) Thomson Micromedex, Greenwood Village, Cololrado, USA, Available at :
http// www.Thomsonhc com.(accessed on 29 October,2010.)
5. Available at: http// www.globalrph.com. (accessed on 7 October ,2010.)
6. Myrna Y. Munar and Harleen Singh. Drug dosing adjustments in patients with chronic kidney disease. Am Fam Physician
2007;75 :1487-96.
7. http://www.medsafe.govt.nz (accessed on 17 March,2011)
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Dosing information in renal impairment
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