Robert W. Schrier. Manual of Nephrology, 6th ed. LWW. 2005: p269-86.

Renal Dose Adjustment

Drug Dose GFR >50 (mL/min) GFR 10–50 (mL/min) GFR <10 (mL/min) Supplemental dose CAPD CRRT
meth after hemodialysis
od
Acarbose D 50–100% Avoid Avoid Unknown Unknown Avoid
Acebutolol D 100% 50% 30–50% None None Dose for GFR 10–50
Acetazolamide I q6h q12h Avoid No data No data Avoid
Acetohexamide I Avoid Avoid Avoid Unknown None Avoid
Acetohydroxamic acid D 100% 100% Avoid Unknown Unknown Unknown
Acetaminophen I q4h q6h q8h None None Dose for GFR 10–50
Acetylsalicylic acid I q4h q4–6h Avoid Dose after dialysis None Dose for GFR 10–50
Acrivastine D Unknown Unknown Unknown Unknown Unknown Unknown
Acyclovir D,I 5 mg/kg q8h 5 mg/kg q12–24h 2.5 mg/kg q24h Dose after dialysis Dose for GFR <10 3.5 mg/kg d
Adenosine D 100% 100% 100% None None Dose for GFR 10–50
Albuterol D 100% 75% 50% Unknown Unknown Dose for GFR 10–50
Alcuronium D Avoid Avoid Avoid Unknown Unknown Avoid
Alfentanil D 100% 100% 100% Not applicable Not applicable NA
Allopurinol D 75% 50% 25% 1/2 dose Unknown Dose for GFR 10–50
Alprazolam D 100% 100% 100% None Unknown NA
Altretamine D Unknown Unknown Unknown No data No data Unknown
Amantadine I q24–48h q48–72h q7d None None Dose for GFR 10–50
Amikacin D,I 60–90% q12h 30–70% q12–18h 20–30% q24–48h 2/3 normal dose 15–20 mg/L d Dose for GFR 10–50
Amiloride D 100% 50% Avoid Not applicable Not applicable Not applicable
Amiodarone D 100% 100% 100% None None Dose for GFR 10–50
Amitriptyline D 100% 100% 100% None Unknown NA
Amlodipine D 100% 100% 100% None None Dose for GFR 10–50
Amoxapine D 100% 100% 100% Unknown Unknown NA
Amoxicillin I q8h q8–12h q24h Dose after dialysis 250 mg q12h Not applicable
Amphotericin I q24h q24h q24–36h None Dose for GFR <10 Dose for GFR 10–50
Amphotericin B coll. I q24h q24h q24–36h None Dose for GFR <10 Dose for GFR 10–50
Amphotericin B lipid I q24h q24h q24–36h None Dose for GFR <10 Dose for GFR 10–50
Ampicillin I q6h q6–12h q12–24h Dose after dialysis 250 mg q12h Dose for GFR 10–50
Amrinone D 100% 100% 50–75% No data No data Dose for GFR 10–50
Anistreplase D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Astemizole D 100% 100% 100% Unknown Unknown NA
Atenolol D,I 100% q24h 50% q48h 30–50% q96h 25–50 mg None Dose for GFR 10–50
Atovaquone – 100% 100% 100% None None Dose for GFR 10–50
Atracurium D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Auranofin D 50% Avoid Avoid None None None
Azathioprine D 100% 75% 50% Yes Unknown Dose for GFR 10–50
Azithromycin D 100% 100% 100% None None None
Azlocillin I q4–6h q6–8h q8h Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Aztreonam D 100% 50–75% 25% 0.5 g after dialysis Dose for GFR <10 Dose for GFR 10–50
Benazepril D 100% 50–75% 25–50% None None Dose for GFR 10–50
Bepridil – Unknown Unknown Unknown None None No data
Betamethasone D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Betaxolol D 100% 100% 50% None None Dose for GFR 10–50
Bezafibrate D 70% 50% 25% Unknown Unknown Dose for GFR 10–50
Bisoprolol D 100% 75% 50% Unknown Unknown Dose for GFR 10–50
Bleomycin I 100% 75% 50% None Unknown Dose for GFR 10–50
Bopindolol D 100% 100% 100% None None Dose for GFR 10–50
Bretylium D 100% 25–50% 25% None None Dose for GFR 10–50
Bromocriptine D 100% 100% 100% Unknown Unknown Unknown
Brompheniramine D 100% 100% 100% Unknown Unknown NA
Budesonide D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Bumetanide D 100% 100% 100% None None Not applicable
Bupropion D 100% 100% 100% Unknown Unknown NA
Buspirone D 100% 100% 100% None Unknown NA
Busulfan D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Butorphanol D 100% 75% 50% Unknown Unknown NA
Capreomycin I q24h q24h q48h Give after HD only None Dose for GFR 10–50
Captopril D,I 100% q8–12h 75% q12–18h 50% q24h 25–30% None Dose for GFR 10–50
Carbamazepine D 100% 100% 100% None None None
Carbidopa D 100% 100% 100% Unknown Unknown Unknown
Carboplatin D 100% 50% 25% 1/2 dose Unknown Dose for GFR 10–50
Carmustine D Unknown Unknown Unknown Unknown Unknown Unknown

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Carteolol D 100% 50% 25 % Unknown None Dose for GFR 10–50
Carvedilol D 100% 100% 100 % None None Dose for GFR 10–50
Cefaclor D 100% 50–100% 50% 250 mg after dialysis 250 mg q8–12h Not applicable
Cefadroxil I q12h q12–24h q24–48h 0.5–1.0 g after dialysis 0.5 g/d Not applicable
Cefamandole I q6h q6–8h q12h 0.5–1.0 g after dialysis 0.5–1.0 g q12h Dose for GFR 10–50
Cefazolin I q8h q12h q24–48h 0.5–1.0 g after dialysis 0.5 g q12h Dose for GFR 10–50
Cefepime I q12h q16–24h q24–48h 1.0 g after dialysis Dose for GFR <10 Not recommended
Cefixime D 100% 75% 50% 300 mg after dialysis 200 mg/d Not recommended
Cefmenoxime D,I 1.0 g q8h 0.75 g q8h 0.75 g q12h 0.75 g after dialysis 0.75 g q12h Dose for GFR 10–50
Cefmetazole I q16h q24h q48h Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Cefonicid D,I 0.5 g/d 0.1–0.5 g/d 0.1 g/d None None None
Cefoperazone D 100% 100% 100% 1 g after dialysis None None
Ceforanide I q12h q12–24h q24–48h 0.5–1.0 g after dialysis None 1.0 g/d
Cefotaxime I q6h q8–12h q24h 1 g after dialysis 1 g/d 1 g q12h
Cefotetan D 100% 50% 25% 1 g after dialysis 1 g/d 750 mg q12h
Cefoxitin I q8h q8–12h q24–48h 1 g after dialysis 1 g/d Dose for GFR 10–50
Cefpodoxime I q12h q16h q24–48h 200 mg after dialysis Dose for GFR <10 Not applicable
Cefprozil D,I 250 mg q12h 250 mg q12–16h 250 mg q24h 250 mg after dialysis Dose for GFR <10 Dose for GFR <10
Ceftazidime I q8–12h q24–48h q48h 1 g after dialysis 0.5 g/d Dose for GFR 10–50
Ceftibutin D 100% 50% 25% 300 mg after dialysis Dose for GFR <10 Dose for GFR 10–50
Ceftizoxime I q8–12h q12–24h q24h 1 g after dialysis 0.5–1.0 g/d Dose for GFR 10–50
Ceftriaxone D 100% 100% 100% Dose after dialysis 750 mg q12h Dose for GFR 10–50
Cefuroxime axetil D 100% 100% 100% Dose after dialysis Dose for GFR <10 Not applicable
Cefuroxime sodium I q8h q8–12h q12h Dose after dialysis Dose for GFR <10 1 g q12h
Celiprolol D 100% 100% 75% Unknown None Dose for GFR 10–50
Cephalexin I q8h q12h q12h Dose after dialysis Dose for GFR <10 Not applicable
Cephalothin I q6h q6-8h q12h Dose after dialysis 1 g q12h 1 g q8h
Cephapirin I q6h q6-8h q12h Dose after dialysis 1 g q12h 1 g q8h
Cephradine D 100% 50% 25% Dose after dialysis Dose for GFR <10 Not applicable
Cetirizine D 100% 100% 30% None Unknown NA
Chloral hydrate D 100% Avoid Avoid None Unknown NA
Chlorambucil D Unknown Unknown Unknown Unknown Unknown Unknown
Chloramphenicol D 100% 100% 100% None None None
Chlorazepate D 100% 100% 100% Unknown Unknown NA
Chlordiazepoxide D 100% 100% 50% None Unknown Dose for GFR 10–50
Chloroquine D 100% 100% 50% None None None
Chlorpheniramine D 100% 100% 100% None Unknown NA
Chlorpromazine D 100% 100% 100% None None Dose for GFR 10–50
Chlorpropamide D 50% Avoid Avoid Unknown None Avoid
Chlorthalidone I q24h q24h Avoid Not Applicable Not applicable Not applicable
Cholestyramine D 100% 100% 100% None None Dose for GFR 10–50
Cibenzoline D,I 100% q12h 100% q12h 60% q24h None None Dose for GFR 10–50
Cidofovir D 50–100% Avoid Avoid No data No data Avoid
Cilastin D 100% 50% Avoid Avoid Avoid Avoid
Cilazapril D,I 75% q24h 50% q24–48h 10–25% q72h None None Dose for GFR 10–50
Cimetidine D 100% 50% 25% None None Dose for GFR 10–50
Cinoxacin D 100% 50% Avoid Avoid Avoid Avoid
Ciprofloxacin D 100% 50–75% 50% 250 mg q12h 250 mg q8h 200 mg iv q12h
Cisapride D 100% 100% 50% Unknown Unknown 50-100%
Cisplatin D 100% 75% 50% Yes Unknown Dose for GFR 10–50
Cladribine D Unknown Unknown Unknown Unknown Unknown Unknown
Clarithromycin D 100% 75% 50–75% Dose after dialysis None None
Clavulanic acid D 100% 100% 50–75% Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Clindamycin D 100% 100% 100% None None None
Clodronate D Unknown Unknown Avoid Unknown Unknown Unknown
Clofazamine – 100% 100 % 100% None None No data
Clofibrate I q6–12h q12–18h Avoid None Unknown Dose for GFR 10–50
Clomipramine D Unknown Unknown Unknown Unknown Unknown NA
Clonazepam D 10o% 100% 100% None Unknown NA
Clonidine D 100% 100% 100% None None Dose for GFR 10–50
Codeine D 100% 75% 50% Unknown Unknown Dose for GFR 10–50
Colchicine D 100% 100% 50% None Unknown Dose for GFR 10–50
Colestipol D 100% 100% 100% None None Dose for GFR 10–50
Cortisone D 100% 100% 100% None Unknown Dose for GFR 10–50
Cyclophosphamide D 100% 100% 75% 1/2 dose Unknown Dose for GFR 10–50
Cycloserine I q12h q12–24h q24h None None Dose for GFR 10–50

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Cyclosporine D 100% 100% 100% None None 100%
Cytarabine D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Dapsone – 100% No data No data None Dose for GFR <10 No data
Daunorubicin D 100% 100% 100% Unknown Unknown Unknown
Delavirdine – 100% 100% 100% None No data Dose for GFR 10–50
Desferoxamine D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Desipramine D 100% 100% 100% None None NA
Dexamethasone D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Diazepam D 100% 100% 100% None Unknown 100%
Diazoxide D 100% 100% 100% None None Dose for GFR 10–50
Diclofenac D 100% 100% 100% None None Dose for GFR 10–50
Dicloxacillin D 100% 100% 100% None None Not applicable
Didanosine I q12h q24h q24–48h Dose after dialysis Dose for GFR <10 Dose for GFR <10
Diflunisal D 100% 50% 50% None None Dose for GFR 10–50
Digitoxin D 100% 100% 50–75% None None Dose for GFR 10–50
Digoxin D,I 100% q24h 25–75% q36h 10–25% q48h None None Dose for GFR 10–50
Dilevalol D 100% 100% 100% None None Unknown
Diltiazem D 100% 100% 100% None None Dose for GFR 10- 50
Diphenhydramine D 100% 100% 190% None None None
Dipyridamole D 100% 100% 100% Unknown Unknown NA
Dirithromycin – 100% 100% 100% None None Dose for GFR 10–50
Disopyramide I q8h q12–24h q24–40h None None Dose for GFR 10–50
Dobutamine D 100% 100% 100% No data No data Dose for GFR 10–50
Doxacurium D 100% 50% 50% Unknown Unknown Dose for GFR 10–50
Doxazosin D 100% 100% 100% None None Dose for GFR 10–50
Doxepin D 100% 100% 100% None None Dose for GFR 10–50
Doxorubicin D 100% 100% 100% None Unknown Dose for GFR 10–50
Doxycycline D 100% 100% 100% None None Dose for GFR 10–50
Dyphylline D 75% 50% 25% l/3 dose Unknown Dose for GFR 10–50
Enalapril D 100% 75–100% 50% 20–25% None Dose for GFR 10–50
Epirubicin D 100% 100% 100% None Unknown Dose for GFR 10–50
Erbastine D 100% 50% 50% Unknown Unknown Dose for GFR 10–50
Erythromycin D 100% 100% 50–75% None None None
Estazolarn D 100% 100% 100% Unknown Unknown NA
Ethacrynic acid I q8–12h q8–12h Avoid None None Not applicable
Ethambutol I q24h q24–36h Q48h Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Ethchlorvynol D 100% Avoid Avoid None None NA
Ethionamide D 100% 100% 50% None None None
Ethosuximide D 100% 100% 100% None Unknown Unknown
Etodolac D 100% 100% 100% None None Dose for GFR 10–50
Etomidate D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Etoposide D 100% 75% 50% None Unknown Dose for GFR 10–50
Famciclovir I 100% q12–48h 50% q48h Dose after dialysis No data Dose for GFR 10–50
Famotidine D 50% 25% 10% None None Dose for GFR 10–50
Fazadinium D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Felodipine D 100% 100% 100% None None Dose for GFR 10–50
Fenoprofen D 100% 100% 100% None None Dose for GFR 10–50
Fentanyl D 100% 75% 50% Not applicable Not applicable NA
Fexofenadine I q12h q12–24h q24h Unknown Unknown Dose for GFR 10–50
Flecainide D 100% 100% 50–75% None None Dose for GFR 10–50
Fleroxacin D 100% 50–75% 50% 400 mg after dialysis 400 mg/d Not applicable
Fluconazole D 100% 100% 100% 200 mg after dialysis Dose for GFR <10 Dose for GFR 10–50
Flucytosine I q12h q16h q24h Dose after dialysis 0.5–1.0 g/d Dose for GFR 10–50
Fludarabine D 100% 75% 50% Unknown Unknown Dose for GFR 10–50
Flumazenil D 100% 100% 100% None Unknown NA
Flunarizine D 100% 100% 100% None None None
Fluorouracil D 100% 100% 100% Yes Unknown Dose for GFR 10–50
Fluoxetine D 100% 100% 100% Unknown Unknown NA
Flurazepam D 100% 100% 100% None Unknown NA
Flurbiprofen D 100% 100% 100% None None Dose for GFR 10–50
Flutamide D 100% 100% 100% Unknown Unknown Unknown
Fluvastatin D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Fluvoxamine D 100% 100% 100% None Unknown NA
Foscarnet D 28 mg/kg 15 mg/kg 6 mg/kg Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Fosinopril D 100% 100% 75–100% None None Dose for GFR 10–50
Furosemide D 100% 100% 100% None None Not applicable

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Gabapentin D,I 400 mg tid 300 mg q12–24h 300 mg qd 300 mg load, then 200- _ Dose for GFR 10–50
300 mg
Gallamine D 75% Avoid Avoid Not applicable Not applicable Dose for GFR 10–50
Ganciclovir I q12h q24–48h q48-96h Dose after dialysis Dose for GFR <10 2.5 mg/kg d
Gemfibrozil D 100% 100% 100% None Unknown Dose for GFR 10–50
Gentamicin D,I 60–90% q8–12h 30–70% q12h 20–30% q24–48h 2/3 normal dose 3–4 mg/L d Dose for GFR 10–50
Glibornuride D Unknown Unknown Unknown Unknown Unknown Avoid
Gliclazide D Unknown Unknown Unknown Unknown Unknown Avoid
Glipizide D 100% 100% 100% Unknown Unknown Avoid
Glyburide D Unknown Avoid Avoid None None Avoid
Gold Na-thiomalate D 50% Avoid Avoid None None Avoid
Griseofulvin D 100% 100% 100% None None None
Guanabenz D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Guanadrel I q12h q12–24h q24–48h Unknown Unknown Dose for GFR 10–50
Guanethidine I q24h q24h q24–36h Unknown Unknown Avoid
Guanfacine D 100% 100% 100% None None Dose for GFR 10–50
Haloperidol D 100% 100% 100% None None Dose for GFR 10–50
Heparin D 100% 100% 100% None None Dose for GFR 10–50
Hexobarbital D 100% 100% 100% None Unknown NA
Hydralazine I q8h q8h q8–16h None None Dose for GFR 10–50
Hydrocortisone D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Hydroxyurea D 100% 50% 20% Unknown Unknown Dose for GFR 10–50
Hydroxyzine D 100% Unknown Unknown 100% 100% 100%
Ibuprofen D 100% 100% 100% None None Dose for GFR 10–50
Idarubicin – Unknown Unknown Unknown Unknown Unknown Unknown
Ifosfamide D 100% 100% 75% Unknown Unknown Dose for GFR 10–50
Iloprost D 100% 100% 50% Unknown Unknown Dose for GFR 10–50
Imipenem D 100% 50% 25% Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Imipramine D 100% 100% 100% None None NA
Indapamide D 100% 100% Avoid None None Not applicable
Indinavir – 100% 100% 100% None Dose for GFR <10 No data
Indobufen D 100% 50% 25% Unknown Unknown NA
Indomethacin D 100% 100% 100% None None Dose for GFR 10–50
Insulin D 100% 75% 50% None None Dose for GFR 10–50
Ipratropium D 100% 100% 100% None None Dose for GFR 10–50
Isoniazid D 100% 100% 50% Dose after dialysis Dose for GFR <10 Dose for GFR <10
Isosorbide D 100% 100% 100% 10-20 mg None Dose for GFR 10–50
Isradipine D 100% 100% 100% None None Dose for GFR 10–50
Itraconazole D 100% 100% 50% 100 mg q12–24h 100 mg q12–24h 100 mg q12–24h
Kanamycin D,I 60– 90% q8–12h 30–70% q12h 20–30% q24–48h 2/3 normal dose 15–20 mg/L d Dose for GFR 10–50
Ketamine D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Ketanserin D 100% 100% 100% None None Dose for GFR 10–50
Ketoconazole D 100% 100% 100% None None None
Ketoprofen D 100% 100% 100% None None Dose for GFR 10–50
Ketorolac D 100% 50% 50% None None Dose for GFR 10–50
Labetolol D 100% 100% 100% None None Dose for GFR 10–50
Lamivudine D,I 100% 50–150 mg qd 25 mg qd Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Lamotrigine D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Lansoprazole D 100% 100% 100% Unknown Unknown Unknown
Levodopa D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Levofloxacin D 100% 50% 25–50% Dose for GFR < 10 Dose for GFR <10 Dose for GFR 10–50
Lidocaine D 100% 100% 100% None None Dose for GFR 10–50
Lincomycin I q6h q6–12h q12–24h None None Not applicable
Lisinopril D 100% 50–75% 25–50% 20% None Dose for GFR 10–50
Lispro Insulin D 100% 75% 50% None None
Lithium carbonate D 100% 50–75% 25–50% Dose after dialysis None Dose for GFR 10–50
Lomefloxacin D 100% 50–75% 50% Dose fo GFR <10 Dose for GFR <10
Loracarbef I q12h q24h q3–5d Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Lorazepam D 100% 100% 100% None Unknown Dose for GFR 10–50
Losartan D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Lovastatin D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
LMWH D 100% 100% 50% Unknown Unknown Dose for GFR 10–50
Maprotiline D 100% 100% 100% Unknown Unknown NA
Meclofenamic acid D 100% 100% 100% None None Dose for GFR 10–50
Mefenamic acid D 100% 100% 100% None None Dose for GFR 10–50
Mefloquine – 100% 100% 100% None None Dose for GFR 10–50

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Melphalan D 100% 75% 50% Unknown Unknown Dose for GFR 10–50
Meperidine D 100% 75% 50% Avoid None Avoid
Meprobamate I q6h q9–12h q12–18h None Unknown NA
Meropenem D,I 500 mg q6h 250 – 500 mg q12h 250 - 500 mg q24h Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Metaproterenol D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Metformin D 50% 25% Avoid Unknown Unknown Avoid
Methadone D 100% 100% 50–75% None None NA
Methenamine D 100% Avoid Avoid Not applicable Not applicable Not applicable
mandelate
Methicillin I q4–6h q6–8h q8–12h None None Dose for GFR 10–50
Methimazole D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Methotrexate D 100% 50% Avoid Yes None Dose for GFR 10–50
Methyldopa I q8h q8–12h q12–24h 250mg None Dose for GFR 10–50
Methylprednisolone D 100% 100% 100% Yes Unknown Dose for GFR 10–50
Metoclopramide D 100% 75% 50% None Unknown 50–75%
Metocurine D 75% 50% 50% Unknown Unknown Dose for GFR 10–50
Metolazone D 100% 100% 100% None None Not applicable
Metoprolol D 100% 100% 100% 50 mg None Dose for GFR 10–50
Metronidazole D 100% 100% 50% Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Mexiletine D 100% 100% 50–75% None None None
Mezlocillin I q4–6h q6–8h q8h None None Dose for GFR 10–50
Miconazole D 100% 100% 100% None None None
Midazolam D 100% 100% 50% Not applicable Not applicable NA
Midodrine – 5–10 mg q8h 5–10 mg q8h Unknown 5 mg q8h No data Dose for GFR 10–50
Miglitol D 50% Avoid Avoid Unknown Unknown Avoid
Milrinone D 100% 100% 50–75% No data No data Dose for GFR 10–50
Minocycline D 100% 100% 100% None None Dose for GFR 10–50
Minoxidil D 100% 100% 100% None None Dose for GFR 10–50
Mitomycin C D 100% 100% 75% Unknown Unknown Unknown
Mitoxantrone D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Mivacurium D 100% 50% 50% Unknown Unknown Unknown
Moricizine D 100% 100% 100% None None Dose for GFR 10–50
Morphine D 100% 75% 50% None Unknown Dose for GFR 10–50
Moxalactam I q8–12h q12–24h q24–48h Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Nabumetone D 100% 100% 100% None None Dose for GFR 10–50
N-Acetylcysteine D 100% 100% 75% Unknown Unknown 100%
Nadolol D 100% 50% 25% 40 mg None Dose for GFR 10–50
Nafcillin D 100% 100% 100% None None Dose for GFR 10–50
Nalidixic acid D 100% Avoid Avoid Avoid Avoid Not applicable
Naloxone D 100% 100% 100% Not applicable Not applicable Dose for GFR 10–50
Naproxen D 100% 100% 100% None None Dose for GFR 10–50
Nefazodone D 100% 100% 100% Unknown Unknown NA
Nelfinavir – No data No data No data No data No data No data
Neostigmine D 100% 50% 25% Unknown Unknown Dose for GFR 10–50
Netilmicin D,I 50–90% q8–12h 20–60% q12h 10–20% q24–48h 2/3 normal dose 3-4 mg/L d Dose for GFR 10–50
Nevirapine D 100% 100% 100% None Dose for GFR <10 Dose for GFR 10–50
Nicardipine D 100% 100% 100% None None Dose for GFR 10–50
Nicotinic acid D 100% 50% 25% Unknown Unknown Dose for GFR 10–50
Nifedipine D 100% 100% 100% None None Dose for GFR 10–50
Nimodipine D 100% 100% 100% None None Dose for GFR 10–50
Nisoldipine D 100% 100% 100% None None Dose for GFR 10–50
Nitrazepam D 100% 100% 100% Unknown Unknown NA
Nitrofurantoin D 100% Avoid Avoid Not applicable Not applicable Not applicable
Nitroglycerine D 100% 100% 100% No data No data Doss for GFR 10–50
Nitroprusside D 100% 100% 100% None None Dose for GFR 10–50
Nitrosoureas D 100% 75% 25–50% None Unknown Unknown
Nizatidine D 75% 50% 25% Unknown Unknown Dose for GFR 10–50
Norfloxacin I q12h q12–24h Avoid Not applicable Not applicable Not applicable
Nortriptyline D 100% 100% 100% None None NA
Ofloxacin D 100% 50% 25–50% 100 mg bid Dose for GFR <10 300 mg/d
Omeprazole D 100% 100% 100% Unknown Unknown Unknown
Ondansetron D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Orphenadrine D 100% 100% 100% Unknown Unknown NA
Ouabain I q12–24h q24–36h q36–48h None None Dose for GFR 10–50
Oxaproxin D 100% 100% 100% None None Dose for GFR 10–50
Oxatomide D 100% 100% 100% None None NA

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Oxazepam D 100% 100% 100% None Unknown Dose for GFR 10–50
Oxcarbazepine D 100% 100% 100% Unknown Unknown Unknown
Paclitaxel D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Pancuronium D 100% 100% Avoid Unknown Unknown Dose for GFR 10–50
Paroxetine D 100% 100% 50% Unknown Unknown NA
PAS D 100% 50–75% 50% Dose after dialysis Dose for GFR <10 Dose for GFR <10
Penbutolol D 100% 100% 100% None None Dose for GFR 10–50
Penicillamine D 100% Avoid Avoid 1/3 dose Unknown Dose for GFR 10–50
Penicillin G D 100% 75% 20–50% Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Penicillin VK D 100% 100% 100% Dose after dialysis Dose for GFR <10 Not applicable
Pentamidine I q24h q24–36h q48h None None None
Pentazocine D 100% 75% 50% None Unknown Dose for GFR 10–50
Pentobarbital D 100% 100% 100% None Unknown Dose for GFR 10–50
Pentopril D 100% 50–75% 50% Unknown Unknown Dose for GFR 10–50
Pentoxifylline D 100% 100% 100% Unknown Unknown 100%
Perfloxacin D 100% 100% 100% None None Dose for GFR 10–50
Perindopril D 100% 75% 50% 25–50% Unknown Dose for GFR. 10-50
Pnenelzine D 100% 100% 100% Unknown Unknown NA
Phenobarbital I q8–12h q8–12h q12–16h Dose after dialysis 1/2 normal dose Dose for GFR 10–50
Phenylbutazone D 100% 100% 100% None None Dose for GFR 10–50
Phenytoin D 100% 100% 100% None None None
Pindolol D 100% 100% 100% None None Dose for GFR 10–50
Pipecuronium D 100% 50% 25 % Unknown Unknown Dose for GFR 10–50
Piperacillin I q4–6h q5–8h q8h Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Piretanide D 100% 100% 100% None None Not applicable
Piroxicam D 100% 100% 100% None None Dose for GFR 10–50
Plicamycin D 100% 75% 50% Unknown Unknown Unknown
Pravastatin D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Prazepam D 100% 100% 100% Unknown Unknown NA
Prazosin D 100% 100% 100% None None Dose for GFR 10–50
Prednisolone D 100% 100% 100% Yes Unknown Dose for GFR 10–50
Prednisone D 100% 100% 100% None Unknown Dose for GFR 10–50
Primaquine – 100% 100% 100% None None Dose for GFR 10–50
Primidone I q8h q3–12h q12–24h 1/3 dose Unknown Unknown
Probenecid D 100% Avoid Avoid Avoid Unknown Avoid
Probucol D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Procainamide I q4h q6–12h q8–24h 200 mg None Dose for GFR 10–50
Promethazine D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Propafenone D 100% 100% 100% None None Dose for GFR 10–50
Propofol D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Propoxyphene D 100% 100% Avoid None None NA
Propranolol D 100% 100% 100% None None Dose for GFR 10–50
Propylthiouracil D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Protryptyline D 100% 100% 100% None None NA
Pyrazinimjde D 100% Avoid Avoid Avoid Avoid Avoid
Pyridostigmine D 50% 35% 20% Unknown Unknown Dose for GFR 10–50
Pyrimethamine D 100% 100% 100% None None None
Quazepam D Unknown Unknown Unknown Unknown Unknown NA
Quinapril D 100% 75–100% 75% 25% None Dose for GFR 10–50
Quinidine D 100% 100% 75% 100–200 mg None Dose for GFR 10–50
Quinine I q8h q8–12h q24h Dose after dialysis Dose for GFR <10 Dose for GFR 10–50
Ramipril D 100% 50–75% 25–50% 20% None Dose for GFR 10–50
Ranitidine D 75% 50% 25% 1/2 dose None Dose for GFR 10–50
Reserpine D 100% 100% Avoid None None Dose for GFR 10–50
Ribavirin D 100% 100% 50% Dose after dialysis Dose for GFR <10 Dose for GFR <10
Rifabutin – 100% 100% 100% None None Dose for GFR 10–50
Rifampin D 100% 50–100% 50–100% None Dose for GFR <10 Dose for GFR <10
Ritonavir – 100% 100% 100% None Dose for GFR <10 Dose for GFR 10–50
Saquinavir – 100% 100% 100% None Dose for GFR <10 Dose for GFR 10–50
Secorbital D 100% 100% 100% None None NA
Sertraline D 100% 100% 100% Unknown Unknown NA
Simvastatin D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Sotalol D 100% 30% 15–30% 30 mg None Dose for GFR 10–50
Sparfloxacin D,I 100% 50–75% 50% q48h Dose for GFR <10 No data Dose for GFR 10–50
Spectinomycin D 100% 100% 100% None None None
Spironolactone I q6–12h q12–24h Avoid Not applicable Not applicable Avoid

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 Robert W. Schrier. Manual of Nephrology, 6th ed. LWW. 2005: p269-86.
Stavudine D,I 100% 50% q12–-24h 50% q24h Dose after dialysis No data Dose for GFR 10–50
Streptokinase D 100% 100% 100% Not applicable Not applicable Dose for GFR 10–50
Streptomycin I q24h q24–72h q72–96h 1/2 normal dose 20–40 mg/L d Dose for GFR 10–50
Streptozotocin D 100% 75% 50% Unknown Unknown Unknown
Succinylcholine D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Sufentanil D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Sulbactam I q6–8h q12–24h q24–48h Dose after dialysis 0.75–1.5 g/d 750 mg q12h
Sulfamethoxazole I q12h q18h q24h 1 g after dialysis 1 g/d Dose for GFR 10–50
Sulfinpyrazone D 100% 100% Avoid None None Dose for GFR 10–50
Sulfisoxazole I q6h q8–12h q12–24h 2 g after dialysis 3 g/d Not applicable
Sulindac D 100% 100% 100% None None Dose for GFR 10–50
Sulotroban D 50% 30% 10% Unknown Unknown Unknown
Tamoxifen D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Tazobactam D 100% 75% 50% 1/3 dose Dose for GFR <10 Dose for GFR 10–50
Teicoplanin I q24h q48h q72h Dose for GFR <10 Dose for GFR < 10 Dose for GFR 10–50
Temazepam D 100% 100% 100% None None NA
Teniposide D 100% 100% 100% None None Dose for GFR 10–50
Terazosin D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Terbutaline D 100% 50% Avoid Unknown Unknown Dose for GFR 10–50
Terfenadine D 100% 100% 100% None None NA
Tetracycline I q8–12h q12–24h q24h None None Dose for GFR 10–50
Theophylline D 100% 100% 100% 1/2 dose Unknown Dose for GFR 10–50
Thiazides D 100% 100% Avoid Not applicable Not applicable Not applicable
Thiopental D 100% 100% 75% Not applicable Not applicable NA
Ticarcillin D,I 1–2 g q4h 1–2 g q8h 1–2 g q12h 3 g after dialysis Dose for GFR <10 Dose for GFR 10–50
Ticlopidine D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Timolol D 100% 100% 100% None None Dose for GFR 10–50
Tobramycin D,I 60% to 90% q8–12h 30–70% q12h 20–30% q24–48h 2/3 normal dose 3–4 mg/L d Dose for GFR 10–50
Tocainide D 100% 100% 50% 200 mg None Dose for GFR 10–50
Tolazamide D 100% 100% 100% Unknown Unknown Avoid
Tolbutamide D 100% 100% 100% None None Avoid
Tolmetin D 100% 100% 100% None None Dose for GFR 10–50
Topiramate D 100% 50% 25% Unknown Unknown Dose for GFR 10–50
Topotecan D 75% 50% 25% Unknown Unknown Dose for GFR 10–50
Torsemide D 100%. 100% 100% None None NA
Tranexamic acid D 50% 25% 10% Unknown Unknown Unknown
Tranylcypromine D Unknown Unknown Unknown Unknown Unknown NA
Trazodone D 100% Unknown Unknown Unknown Unknown NA
Triamcinolone D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Triamterene I q12h q12h Avoid Not applicable Not applicable Avoid
Triazolam D 100% 100% 100% None None NA
Trihexyphenidyl D Unknown Unknown Unknown Unknown Unknown Unknown
Trimethadione I q8h q8–12h q12–24h Unknown Unknown Dose for GFR 10–50
Trimethoprim I q12h q18h q24h Dose after dialysis q24h q18h
Trimetrexate D 100% 50-100% Avoid No data No data No data
Trimipramine D 100% 100% 100% None None NA
Tripelennamine D Unknown Unknown Unknown Unknown Unknown NA
Triprolidine D Unknown Unknown Unknown Unknown Unknown NA
Tubocurarine D 75% 50% Avoid Unknown Unknown Dose for GFR 10–50
Urokinase D Unknown Unknown Unknown Unknown Unknown Dose for GFR 10–50
Valproate (sodium) D 100% 100% 100% None None None
Vancomycin D,I 500 mg q6–12h 500 mg q24–48h 500 mg q48–96h Dose for GFR <10 Dose for GFR <10 Dose for GFR 10–50
Vecuronium D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Venlafaxine D 75% 50% 50% None Unknown NA
Verapamil D 100% 100% 100% None None Dose for GFR 10–50
Vidarabine D 100% 100% 75% Infuse after dialysis Dose for GFR <10 Dose for GFR 10–50
Vigabatrin D 100% 50% 25% Unknown Unknown Dose for GFR 10–50
Vinblastine D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Vincristine D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Vinorelbine D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Warfarin D 100% 100% 100% None None None
Zafirlukast D 100% 100% 100% Unknown Unknown Dose for GFR 10–50
Zalcitabine I 100% q12h q24h Dose after dialysis No data Dose for GFR 10–50
Zidovudine (AZT) D,I 200 mg q8h 200 mg q8h 100 mg q8h Dose for GFR <10 Dose for GFR <10 100 mg q8h
Zileuton – 100% 100% 100% None Unknown Dose for GFR 10–50

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