TABLE 57-4 -- Drug Doses in Renal Failure

GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Acarbose D 100% Avoid Avoid Unknown Unknown Avoid
Acebutolol D 100% 50% 3050% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Acetaminoph I q4h q6h q8h Dose as Dose as As normal
en GFR < 10 GFR < 10 GFR
Acetazolamid I q6h q12h Avoid No data No data Avoid
e
Acetohexami I Avoid Avoid Avoid Avoid Avoid Avoid
de
Acetohydroxa D 100% 100% Avoid Unknown Unknown Unknown
mic Acid
Acetylsalicycl I q4h q46h Avoid As normal As normal As normal
ic Acid GFR GFR GFR
Dose post
HD
Acrivastine D 8 mg 8 mg q12 8 mg q24h Dose as Dose as Dose as
q12h 24h GFR < 10 GFR < 10 GFR 10
50
Aciclovir D, I 5 5 mg/kg 2.5 mg/kg Dose as Dose as 3.5
mg/kg q1224h q24h GFR < 10 GFR < 10 mg/kg/day
q8h
Dose post
HD
Adenosine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Albuterol D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Alfentanil D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Allopurinol D 75% 50% 33% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Alprazolam D 100% 100% 100% Unknown Unknown NA
Alteplase (t- 100% 100% 100% As normal As normal As normal
PA) GFR GFR GFR
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Altretamine D Unkno Unknown Unknown No data No data Unknown
wn
Amantadine I q24 q4872h q7d Dose as Dose as Dose as
48h GFR < 10 GFR < 10 GFR 10
50
Amikacin D, I 60 3070% 2030% 5 mg/kg 1520 Dose as
90% q1218h q2448h post HD mg/L/day GFR 10
q12h 50
Amiloride D 100% 50% Avoid NA NA NA
Aminophyllin D 100% 200400 200300 Dose as Dose as Dose as
e mg q12h mg q12h GFR < 10 GFR < 10 GFR 10
50
Amiodarone D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Amitriptyline D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Amlodipine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Amoxapine D 100% 100% 100% Unknown Unknown NA
Amoxicillin I q8h q812h q24h Dose as 250 mg As normal
GFR < 10 q8h GFR
Dose post
HD
Amphotericin I q24h q24h q2436h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Amphotericin I q24h q24h q2436h Dose as Dose as Dose for
B Colloidal GFR < 10 GFR < 10 GFR 10
50
Amphotericin I q24h q24h q2436h Dose as Dose as Dose as
B lipid GFR < 10 GFR < 10 GFR 10
50
Ampicillin I q6h q612h q1224h Dose as Dose as Dose as G
GFR < 10 GFR < 10 FR 1050
Dose post
HD
Amrinone D 100% 100% 5075% No data No data Dose as
GFR 10
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
50
Anistreplase D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Astemizole D 100% 100% 100% Unknown Unknown NA
Atenolol D, I 100% 100% 50% q24h Dose as Dose as As normal
q24h q24h GFR < 10 GFR < 10 GFR
Atovaquone 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Atracurium D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Auranofin D 36 mg 3 mg q24h Avoid Avoid Avoid Dose as
q24h GFR 10
50
Azathioprine D 100% 75% 50% As normal Dose as Dose as
GFR GFR < 10 GFR 10
50
Azithromycin D 100% 100% 100% No data No data No data
Azlocillin I q46h q68h q8h Dose as Dose for Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Aztreonam D 100% 5075% 25% Dose as Dose for Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Basiliximab 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Benazepril D 100% 5075% 2550% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Betamethason D 100% 100% 100% As normal As normal As normal
e GFR GFR GFR
Betaxolol D 100% 100% 50% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Bezafibrate D 70% 50% q24 Avoid 200 mg 200 mg Dose as
48h q72h q72h GFR 10
50
Bisoprolol D 100% 100% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Bleomycin D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Bopindolol D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Bretylium D 100% 2550% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Bromocriptin D 100% 100% 100% As normal As normal As normal
e GFR GFR GFR
Bromphenira D 100% 100% 100% As normal As normal As normal
mine GFR GFR GFR
Budesonide D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Bumetanide D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Bupropion D 100% 100% 100% Dose as Dose as Dose as
q24h q24h q24h GFR < 10 GFR < 10 GFR 10
50
Buspirone D 100% 100% 100% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR

50% if 50% if
anuric anuric
Busulfan D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Butorphanol D 100% 75% 50% Unknown Unknown NA
Capreomycin I q24h q24h q48h Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Captopril D, I 100% 75% q12 50% q24h Dose as Dose as Dose as
q812h 18h GFR < 10 GFR < 10 GFR 10
50
Carbamazepi D 100% 100% 100% As normal As normal As normal
ne GFR GFR GFR
Carbidopa D 100% 100% 100% Unknown Unknown Unknown
Carboplatin D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Carmustine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Carteolol D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Carvedilol D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Cefaclor D 100% 50100% 50% 250500 250 mg As normal
mg q8h q812h GFR
Cefadroxil I q12h q1224h q2448h 0.51.0 g 0.5 g/day As normal
post HD GFR
Cefamandole I q6h q68h q12h 0.51.0 g 0.51.0 g Dose as
q12h q12h GFR 10
50
Dose post
HD
Cefazolin I q8h q12h q2448h 0.51.0 g 0.5 g q12h Dose as
post HD GFR 10
50
Cefepime I q12h q1624h q2448h 1.0 g post Dose for Not
HD GFR < 10 recommen
ded
Cefixime D 100% 75% 50% 200 mg 200 mg Dose as
q24h q24h GFR 10
50
Dose post
HD
Cefmenoxime D, I 1.0 g 0.75 g q8h 0.75 g 0.75 g 0.75 g Dose as
q8h q12h q12h q12h GFR 10
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
50
Dose post
HD
Cefmetazole I q16h q24h q48h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Cefonicid D, I 0.5 g/d 0.1 g0.5 0.1 g/day Dose as Dose as Dose as
g/day GFR < 10 GFR < 10 GFR 10
50
Ceforanide I q12h q1224h q2448h 0.51.0 g None 1.0 g/day
post HD
Cefotaxime I 100% 100% q8h 50% q8 Dose as 1 g q24h 1 g q12h
q8h 12h GFR < 10
Dose post
HD
Cefotetan D 100% 50% 25% 250500 1 g q24h 750 mg
mg q24h q12h
+500 mg
post HD
Cefoxitin I 100% 12 g q8 0.51 g 0.51 g 1 g q24h Dose as
24h q1224h q2448h GFR 10
50
+1 g post
HD
Cefpodoxime I 100% 100% 100200 Dose as Dose as As normal
mg GFR < 10 GFR < 10 GFR
q2448h
Cefprozil D, I 100% 50% q24h 50% q24h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR < 10
Dose post
HD
Ceftazidime I 100% 0.51 g 0.51 g 1 g post 0.51 g 0.51 g
q1224h q48h HD q24h q12h
Ceftibuten D 100% 50% 25% 400 mg Dose as Dose as
post HD GFR < 10 GFR 10
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
50
Ceftizoxime I 0.51.5 0.251 g 0.250.5 g 0.250.5 g 0.51.0 g Dose as
g q8h q12h q24h q24h q24h GFR 10
50
Dose post
HD
Ceftriaxone D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Dose post
HD
Cefuroxime D 100% 100% 250 mg Dose as Dose as As normal
axetil (oral) q24h GFR < 10 GFR < 10 GFR
Dose post
HD
Cefuroxime 100% 0.751.5 g 750 mg 750 mg 750 mg Dose as
(iv) q812h q12h q24h q24h GFR 10
50
Dose post
HD
Celiprolol D 100% 100% 75% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Cephalexin I 250 250500 250500 Dose as Dose as Dose as
500 mg mg q812h mg GFR < 10 GFR < 10 GFR 10
q6h 50
q1224h Dose post
HD
Cephalothin I q6h q68h q12h Dose as Dose as 1 g q8h
GFR < 10 GFR < 10
Dose post
HD
Cephapirin I q6h q68h q12h Dose as Dose as 1 g q8h
GFR < 10 GFR < 10
Dose post
HD
Cephradine D 100% 50% 25% Dose as Dose for As normal
GFR < 10 GFR < 10 GFR
Dose post
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
dialysis
Cetirizine D 100% 100% 50% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Chloralhydrat D 100% Avoid Avoid Avoid Avoid Avoid
e
Chlorambucil D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Chlorampheni D 100% 100% 100% As normal As normal As normal
col GFR GFR GFR
Chlorazepate D 100% 100% 100% Unknown Unknown NA
Chlordiazepo D 100% 100% 50% Dose as Dose as As normal
xide GFR < 10 GFR < 10 GFR
Chloroquine D 100% 100% 50% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Chlorphenira D 100% 100% 50% Dose as Dose as Dose as
mine GFR < 10 GFR < 10 GFR 10
50
Chlorpromazi D 100% 100% 100% As normal As normal As normal
ne GFR GFR GFR
Chlorpropami D 50% Avoid Avoid Avoid Avoid Avoid
de
Chlorthalidon I 100% 100% Avoid Avoid Avoid NA
e
Cholestyrami D 100% 100% 100% As normal As normal As normal
ne GFR GFR GFR
Cibenzoline D, I 100% 100% 66% q24h Dose as Dose as Dose as
q12h q12h GFR < 10 GFR < 10 GFR 10
50
Cidofovir D 50 Avoid Avoid No data No data Avoid
100%
Cilastin D 100% 50% Avoid Avoid Avoid Avoid
Cilazapril D, I 75% 50% q24 1025% Dose as Dose as Dose as
q24h 48h q72h GFR < 10 GFR < 10 GFR 10
50
Cimetidine D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Cinoxacin D 100% 50% Avoid Avoid Avoid Avoid
Ciprofloxacin D 100% 5075% 50% 250 mg 250 mg 200 mg IV
q12h q8h q12h
Cisapride D 100% 50% 50% Dose as Dose as 50100%
GFR < 10 GFR < 10
Cisplatin D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Cladribine D Unkno Unknown Unknown Unknown Unknown Unknown
wn
Clarithromyci D 100% 75% 5075% Dose as Dose as Dose as
n GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Clavulanic D 100% 100% 5075% Dose as Dose as Dose as
acid GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Clindamycin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Clodronate D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Clofazimine 100% 100% 100% Dose as Dose as No data
GFR < 10 GFR < 10
Clofibrate I q612h q1218h Avoid Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Clomipramin D 100% Start at lower dose and Dose as Dose as Dose as
e monitor effect GFR < 10 GFR < 10 GFR 10
50
Clonazepam D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Clonidine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Codeine D 100% 75% 50% Dose as Dose as Dose as
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
GFR < 10 GFR < 10 GFR 10
50
Colchicine D 100% 100% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Colestipol D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Cortisone D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Cyclophospha D 100% 75100% 5075% Dose as Dose as Dose as
mide GFR < 10 GFR < 10 GFR 10
50
Cycloserine I q12h q1224h q24h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Cyclosporine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Cytarabine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dapsone 100% 100% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Daunorubicin D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Delavirdine 100% 100% 100% Dose as No data Dose as
GFR < 10 GFR 10
50
Desferrioxam D 100% 100% 50% Unknown Unknown Dose as
ine GFR 10
50
Desipramine D 100% 100% 100% Dose as Dose as NA
GFR < 10 GFR < 10
Dexamethaso D 100% 100% 100% As normal As normal As normal
ne GFR GFR GFR
Diazepam D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Diazoxide D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Diclofenac D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Dicloxacillin D 100% 100% 100% Dose as Dose as NA
GFR < 10 GFR < 10
Didanosine I 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Diflunisal D 100% 50% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Digitoxin D 100% 100% 5075% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Digoxin D, I 100% 2575% 1025% Dose as Dose as Dose as
q24h q36h q48h GFR < 10 GFR < 10 GFR 10
50
Dilevalol D 100% 100% 100% Dose as Dose as Unknown
GFR < 10 GFR < 10
Diltiazem D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Diphenhydra D 100% 100% 100% Dose as Dose as Dose as
mine GFR < 10 GFR < 10 GFR 10
50
Dipyridamole D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Dirithromycin 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Disopyramide I q8h q12h q2440h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dobutamine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Doxacurium D 100% 50% 50% Unknown Unknown Dose as
GFR 10
50
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Doxazosin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Doxepin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Doxorubicin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Doxycycline D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Dyphylline D 75% 50% 25% dose Unknown Dose as
GFR 10
50
Ebastine D 100% 50% 50% Unknown Unknown Dose as
GFR 10
50
Enalapril D 100% 75100% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Epirubicin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Erythromycin D 100% 100% 5075% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Estazolam D 100% 100% 100% Unknown Unknown NA
Etanercept 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Ethambutol I q24h q2436h q48h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Ethchlorvynol D 100% Avoid Avoid Dose as Dose as NA
GFR < 10 GFR < 10
Ethionamide D 100% 100% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Ethosuximide D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Etodolac D 100% 100% 100% As normal As normal Dose as
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
GFR GFR GFR 10
50
Etomidate D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Etoposide D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Famciclovir I 100% q1248h 50% q48h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Famotidine D 100% 50% 20 mg Dose as Dose as Dose as
q24h GFR < 10 GFR < 10 GFR 10
50
Fazadinium D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Felodipine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Fenoprofen D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Fentanyl D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Fexofenadine I q12h q1224h q24h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Flecainide D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Fleroxacin D 100% 50% 50% 400 mg 400 Dose as
post HD mg/24h GFR 10
50
Fluconazole D 100% 100% 50% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Dose post
HD
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Flucytosine I q12h q16h q24h Dose as 0.5/24h Dose as
GFR < 10 GFR 10
50
Dose post
HD
Fludarabine D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Flumazenil D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Flunarizine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Fluorouracil D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Fluoxetine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Flurazepam D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Flurbiprofen D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Flutamide D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Fluvastatin D 100% 100% 50% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Fluvoxamine D 100% 100% 100% Dose as Unknown NA
GFR < 10
Foscarnet D 28 15 6 Dose as Dose as Dose as
mg/kg/ mg/kg/q8h mg/kg/q8h GFR < 10 GFR < 10 GFR 10
q8h 50
Dose post
HD
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Fosinopril D 100% 100% 75100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Furosemide D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Gabapentin D, I 400 mg 300 mg 300 mg 300 mg Dose as Dose as
q8h q1224h q48h load then GFR < 10 GFR 10
50
200 mg
post HD
Gallamine D 75% Avoid Avoid NA NA Dose as
GFR 10
50
Ganciclovir I 2.55 1.252.5 1.25 Dose as Dose as 2.5 mg/kg
mg/kg mg/kg mg/kg GFR < 10 GFR < 10 q24h
q12h q24h q24h
Dose post
HD
Gemfibrozil D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Gentamicin D, I 60 3070% 2030% Dose as 34 Dose as
90% q12h q2472h GFR < 10 mg/L/day GFR 10
q812h 50
Dose post
HD
Glibornuride D Unkno Unknown Unknown Unknown Unknown Avoid
wn
Gliclazide D 100% 2040 2040 Dose as Dose as Dose as
mg/day mg/day GFR < 10 GFR < 10 GFR 10
50
Glipizide D 100% 100% Contraindi Dose as Dose as Avoid
cated GFR < 10 GFR < 10
Glyburide D Unkno Avoid Avoid Avoid Avoid Avoid
wn
Gold Sodium D 50% Avoid Avoid Dose as Dose as Avoid
Thiomalate GFR < 10 GFR < 10
Griseofulvin D 100% 100% 100% As normal As normal As normal
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
GFR GFR GFR
Guanabenz D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Guanadrel I q12h q1224h q2448h Unknown Unknown Dose as
GFR 10
50
Guanethidine I q24h q24h q2436h Unknown Unknown Avoid
Guanfacine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Haloperidol D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Heparin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Hexobarbital D 100% 100% 100% Dose as Unknown NA
GFR < 10
Hydralazine I q8h q8h q816h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Hydrocortiso D 100% 100% 100% As normal As normal As normal
ne GFR GFR GFR
Hydroxyurea D 100% 50% 20% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Hydroxyzine D 100% Unknown Unknown 100% 100% 100%
Ibuprofen D 100% 100% 100% As normal As normal Dose as
GFR GFR GFR 10
50
Idarubicin Unkno Unknown Unknown Unknown Unknown Unknown
wn
Ifosfamide D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Iloprost D 100% 100% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Imipenem D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Imipramine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Indapamide D 100% 100% 50% Dose as Dose as NA
GFR < 10 GFR < 10
Indinavir 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Indobufen D 100% 50% 25% Unknown Unknown NA
Indomethacin D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Infliximab 100% No data No data No data No data No data
Insulin D Variabl Variable Variable Variable Variable Variable
(soluble) e
Ipratropium D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Isoniazid D 100% 100% 75% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Dose post
HD
Isosorbide D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Dose post
HD
Isradipine D 100% 100% 100 As normal As normal As normal
GFR GFR GFR
Itraconazole D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Kanamycin D, I 60 3070% 2030% normal 1520 Dose as
90% q12h q2448h dose mg/L/day GFR 10
q812h 50
Ketamine D 100% 100% 100% Unknown Unknown Dose as
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
GFR 10
50
Ketanserin D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Ketoconazole D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Ketoprofen D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Ketorolac D 100% 50% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Labetolol D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Lamivudine D, I 100% 50150 mg 25 mg qd Dose as Dose as Dose as
qd GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Lamotrigine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Lansoprazole D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Lepirudin 0.4 50% bolus Avoid Dose as Dose as 50% bolus
mg/kg GFR < 10 GFR < 10
bolus
0.15 1530% 15%
mg/kg/
h
Levodopa D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Levofloxacin D 100% 50% 2550% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Lidocaine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
50
Lincomycin I q6h q612h q1224h Dose as Dose as NA
GFR < 10 GFR < 10
Linezolid D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Caution
Lisinopril D 100% 5075% 2550% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Lispro Insulin D Variabl Variable Variable Variable Variable Variable
e
Lithium D 100% 5075% 2550% Dose as Dose as Dose as
carbonate GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Lomefloxacin D 100% 5075% 50% Dose as Dose as NA
GFR < 10 GFR < 10
Loracarbef I q12h q24h q35d Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Lorazepam D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Losartan D 100% 100% 100% 25 mg/24h 25 mg/24h Dose as
and titrate and titrate GFR 10
50
Lovastatin D 100% 100% 100% Unknown Unknown Dose for
GFR
Low- D 100% Prophylact Prophylact Dose as Dose as Dose as
molecular- ic dose ic dose GFR < 10 GFR < 10 GFR 10
weight only only 50
heparin
Maprotiline D 100% 100% 100% Unknown Unknown NA
Meclofenami D 100% 100% 100% Dose as Dose as Dose as
c acid GFR < 10 GFR < 10 GFR 10
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
50
Mefenamic D 100% 100% 50% Dose as Dose as Dose as
acid GFR < 10 GFR < 10 GFR 10
50
Mefloquine 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Melphalan D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Meperidine D 100% 75% 50% Avoid Avoid Avoid
Meprobamate I q6h q912h q1218h Dose as Dose as NA
GFR < 10 GFR < 10
Meropenem D, I 500 mg 250500 250500 Dose as Dose as Dose as
q6h mg q12h mg q24h GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Metaproteren D 100% 100% 100% Unknown Unknown Dose as
ol GFR 10
50
Metformin D 50% Avoid Avoid Avoid Avoid Avoid
Methadone D 100% 100% 5075% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Methenamine D 100% Avoid Avoid NA NA NA
Mandelate
Methicillin I q46h q68h q812h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Methimazole D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Methotrexate D 100% 50% Contraindi Contraindi Contraindi Dose as
cated cated cated GFR 10
50
Methyldopa I q8h q812h q1224h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Dose post
HD
Methylpredni D 100% 100% 100% As normal As normal As normal
solone GFR GFR GFR
Dose post
HD
Metocloprami D 100% 75% 50% Dose as Dose as 5075%
de GFR < 10 GFR < 10
Metocurine D 75% 50% 50% Unknown Unknown Dose as
GFR 10
50
Metolazone D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Metoprolol D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Metronidazol D 100% 100% q8 100% As normal Dose as As normal
e q812h 12h q12h GFR GFR < 10 GFR
Dose post
HD
Mexiletine D 100% 100% 5075% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Mezlocillin I q46h q68h q8h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Miconazole D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Midazolam D 100% 100% 50% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Midodrine 510 510 mg 2.510 mg Dose as Dose as Dose as
mg q8h q8h q8h GFR < 10 GFR < 10 GFR 10
50
Miglitol D 50% Avoid Avoid Unknown Unknown Avoid
Milrinone D 100% 100% 50 to 75% No data No data Dose as
GFR 10
50
Minocycline D 100% 100% 100% None None Dose as
GFR 10
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
50
Minoxidil D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Mitomycin C D 100% 100% 75% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Mitoxantrone D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Mivacurium D 100% 50% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Moricizine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Morphine D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Moxalactam I q812h q1224h q2448h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Mycophenola D 100% 50100% 50100% Dose as Dose as As normal
te mofetil GFR < 10 GFR < 10 GFR
Nabumetone D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
N- D 100% 100% 75% Dose as Dose as 100%
Acetylcystein GFR < 10 GFR < 10
e
Nadolol D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Nafcillin D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Nalidixic acid D 100% Avoid Avoid Avoid Avoid Avoid
Naloxone D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Naproxen D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Nefazodone D 100% 100% 100% Unknown Unknown NA
Nefopam D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Nelfinavir No No data No data No data No data No data
data
Neostigmine D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Netilmicin D, I 50 2060% 10% q24h 2 mg/kg IV: 2 Dose as
90% q24h post each mg/kg GFR 10
q812h q48h 50
HD IP: 7.510
session mg/LPE
Nevirapine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Nicardipine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Nicotinic acid D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Nifedipine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Nimodipine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Nisoldipine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Nitrazepam D 100% 100% 100% Dose as Dose as As normal
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
GFR < 10 GFR < 10 GFR
Nitrofurantoi D Avoid Contraindi Contraindi Contraindi Contraindi Contraindi
n cated cated cated cated cated
Nitroglycerin D 100% 100% 100% No data No data Dose as
e GFR 10
50
Nitroprusside D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Nitrosoureas D 100% 75% 2550% Dose as Unknown Unknown
GFR < 10
Nizatidine D 75% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Norfloxacin I q12h q1224h Avoid NA NA NA
Nortriptyline D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Ofloxacin D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Omeprazole D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Ondansetron D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Orphenadrine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Oxaprozin D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Oxatomide D 100% 100% 100% Dose as Dose as NA
GFR < 10 GFR < 10
Oxazepam D 100% 100% 75% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Oxcarbazepin D 100% 100% 100% Unknown Unknown Unknown
e
Paclitaxel D 100% 100% 100% As normal As normal Dose as
GFR GFR GFR 10
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
50
Pancuronium D 100% 50% Avoid Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Paroxetine D 100% 5075% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Paraamino D 100% 5075% 50% Dose as Dose as Dose as
salicylic acid GFR < 10 GFR < 10 GFR 10
(PAS) 50
Dose after
dialysis
Penbutolol D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Penicillamine D 100% Avoid Avoid 125250 Avoid Avoid
mg thrice
weekly
post HD
Penicillin G D 100% 75% 2050% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Penicillin VK D 100% 100% 100% Dose as Dose as NA
GFR < 10 GFR < 10
Dose post
HD
Pentamidine I q24h q2436h q48h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Pentazocine D 100% 75% 50% Dose as Unknown Dose as
GFR < 10 GFR 10
50
Pentobarbital D 100% 100% 100% Dose as Unknown Dose as
GFR < 10 GFR 10
50
Pentopril D 100% 5075% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Pentoxifylline D 100% 100% 100% Unknown Unknown 100%
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Pefloxacin D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Perindopril D 100% 75% 50% 2550% Unknown Dose as
GFR 10
50
Phenelzine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Phenobarbital I q812h q812h q1216h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Phenylbutazo D 100% 100% 100% Dose as Dose as Dose as
ne GFR < 10 GFR < 10 GFR 10
50
Phenytoin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Pindolol D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Pioglitazone D 100% 100% 100% with As normal As normal As normal
caution GFR with GFR with GFR with
caution caution caution
Pipecuronium D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Piperacillin I q46h q68h q8h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Piretanide D 100% 100% 100% Dose as Dose as NA
GFR < 10 GFR < 10
Piroxicam D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Plicamycin D 100% 75% 50% Unknown Unknown Unknown
Pravastatin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Prazepam D 100% 100% 100% Unknown Unknown NA
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Prazosin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Prednisolone D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Dose post
HD
Prednisone D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Pregabalin D 100% 50% q8 25% q24h Dose as Dose as No data
q812h 12h GFR < 10 GFR < 10
Extra dose
post HD
Primaquine 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Primidone I q8h q812h q1224h dose Unknown Unknown
Probenecid D 100% Avoid Avoid Avoid Avoid Avoid
Probucol D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Procainamide I q4h q612h Avoid Avoid Avoid Avoid
Promethazine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Propafenone D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Propofol D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Propoxyphen D 100% 100% Avoid Avoid Avoid NA
e
Propranolol D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Propylthioura D 100% 75% 50% Dose as Dose as Dose as
cil GFR < 10 GFR < 10 GFR 10
50
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Protryptyline D 100% 100% 100% Dose as Dose as NA
GFR < 10 GFR < 10
Pyrazinimide D 100% As normal As normal As normal As normal As normal
GFR GFR GFR GFR GFR
Pyridostigmin D 50% 35% 20% Dose as Dose as Dose as
e GFR < 10 GFR < 10 GFR 10
50
Pyrimethamin D 100% 100% 100% As normal As normal As normal
e GFR GFR GFR
Quazepam D Unkno Unknown Unknown Unknown Unknown NA
wn
Quinapril D 100% 75100% 50% Dose as Dose as Dose as
GFR 10 GFR < 10 GFR 10
50 50
Quinidine D 100% 100% 100% Dose as As normal As normal
GFR < 10 GFR GFR
Quinine I q8h q812h q24h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Ramipril D 100% 5075% 2550% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Ranitidine D 100% 100% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Ribavirin D 100% 100% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Rifabutin 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Rifampin D 100% 50100% 50100% Dose as Dose as As normal
GFR < 10 GFR < 10 GFR
Ritonavir 100% 100% 100% As normal As normal As normal
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
GFR GFR GFR
Rituximab 100% 100% Use 100% Use 100% Use 100% Use 100% Use
with with with with with
caution caution caution caution caution
Rosiglitazone D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Saquinavir 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Secobarbital D 100% 100% 100% Dose as Dose as NA
GFR < 10 GFR < 10
Sertraline D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Simvastatin D 100% 100% 10 mg Dose as Dose as As normal
q24h GFR < 10 GFR < 10 GFR
Sodium D 100% 100% 100% As normal As normal As normal
valproate GFR GFR GFR
Sotalol D 100% 2550% Avoid Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Sparfloxacin D, I 100% 5075% 50% q48h Dose as No data Dose as
GFR < 10 GFR 10
50
Spectinomyci D 100% 100% 100% Dose as Dose as Dose as
n GFR < 10 GFR < 10 GFR 10
50
Spironolacton I q612h q1224h Avoid Dose as Dose as Avoid
e GFR < 10 GFR < 10
Stavudine D, I 100% 50% q12 50% q24h Dose as Dose as Dose as
24h GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Streptokinase D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Streptomycin I q24h q2472h q7296h 750 mg 2 2040 Dose as
3/week mg/L/day GFR 10
50
Streptozotoci D 100% 75% 50% Unknown Unknown Unknown
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
n
Succinylcholi D 100% 100% 100% Unknown Unknown Dose as
ne GFR 10
50
Sufentanil D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Sulbactam I q68h q1224h q2448h Dose as 0.751.5 750 mg
GFR < 10 g/day q12h
Dose post
HD
Sulfamethoxa I q12h q18h q24h 1 g after 1 g/day Dose as
zole dialysis GFR 10
50
Sulfinpyrazon D 100% 100% Avoid None None Dose as
e GFR 10
50
Sulfisoxazole I q6h q812h q1224h 2 g after 3 g/day NA
dialysis
Sulindac D 100% 50100% 50100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Sulotroban D 50% 30% 10% Unknown Unknown Unknown
Tacrolimus 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Tamoxifen D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Tazobactam D 100% 75% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Teicoplanin I q24h q4872h q72h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Temazepam D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Teniposide D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
50
Terazosin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Terbutaline D 100% 50% Avoid Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Terfenadine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Tetracycline I q812h q1224h q24h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Thiazides D 100% 100% Avoid Dose as Dose as NA
GFR < 10 GFR < 10
Thiopental D 100% 100% 75% NA NA NA
Ticarcillin D, I 12 g 12 g q8h 12 g q12h 3 g after Dose as Dose as
q4h dialysis GFR < 10 GFR 10
50
Ticlopidine D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Tigecycline 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Timolol D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Tobramycin D, I 60 3070% 2030% normal 34 Dose as
90% q12h q2448h dose mg/L/day GFR 10
q812h 50
Tolazamide D 100% 100% 100% Unknown Unknown Avoid
Tolbutamide D 100% 100% 100% Dose as Dose as Avoid
GFR < 10 GFR < 10
Tolmetin D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Topiramate D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
Topotecan D 75% 50% 25% No data No data No data
Torsemide D 100% 100% 100% Dose as Dose as NA
GFR < 10 GFR < 10
Tramadol D 100% 50100 mg 50 mg Dose as Dose as Dose as
q612h q12h GFR < 10 GFR < 10 GFR 10
50
Tranexamic D 50% 25% 10% Dose as Dose as Dose as
acid GFR < 10 GFR < 10 GFR 10
50
Tranylcyprom D Unkno Unknown Unknown Unknown Unknown NA
ine wn
Trazodone D 100% 100% Avoid/50 Dose as Dose as Dose as
% GFR < 10 GFR < 10 GFR 10
50
Triamcinolon D 100% 100% 100% As normal As normal As normal
e GFR GFR GFR
Triamterene I q12h q12h Avoid Avoid Avoid Avoid
Triazolam D 100% 100% 100% Dose as Dose as NA
GFR < 10 GFR < 10
Trihexypheni D Unkno Unknown Unknown Unknown Unknown Unknown
dyl wn
Trimethadion I q8h q812h q1224h Unknown Unknown Dose as
e GFR 10
50
Trimethoprim I q12h 50% q18h 50% q24h Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Dose post
HD
Trimetrexate D 100% 50100% Avoid No data No data No data
Trimipramine D 100% 100% 100% Dose as Dose as NA
GFR < 10 GFR < 10
Tripelennami D Unkno Unknown Unknown Unknown Unknown NA
ne wn
Triprolidine D Unkno Unknown Unknown Unknown Unknown NA
wn
Tubocurarine D 75% 50% Avoid Unknown Unknown Dose as
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
GFR 10
50
Urokinase D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Valganciclovi D 50 450 mg 450 mg Avoid Avoid 450 mg
r 100% q2448h BiW q48h
Vancomycin D, I 500 mg 500 mg 500 mg Dose as Dose as Dose as
q612h q1248h q4896h GFR < 10 GFR < 10 GFR 10
50
Vecuronium D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Venlafaxine D 100% 50% 50% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Verapamil D 100% 100% 100% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Vidarabine D 100% 100% 75% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Infuse post
HD
Vigabatrin D 100% 50% 25% Dose as Dose as Dose as
GFR < 10 GFR < 10 GFR 10
50
Vinblastine D 100% 100% 100% 100% 2 As normal As normal
3/week GFR GFR
Dose post
HD
Vincristine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Vinorelbine D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Warfarin D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Zafirlukast D 100% 100% 100% As normal As normal As normal
GFR GFR GFR
Zalcitabine I 100% q12h q24h Dose as No data Dose as
 GFR >
Dose 50 GFR 10
Meth (mL/mi 50 GFR < 10
Drug od n) (mL/min) (mL/min) HD CAPD CRRT
GFR < 10 GFR 10
50
Dose post
HD
Zidovudine D, I 100% 100% q8h 50% q12h Dose as Dose as Dose as
(AZT) q8h GFR < 10 GFR < 10 GFR 10
50
Zileuton 100% 100% 100% Dose as Unknown Dose as
GFR < 10 GFR 10
50
CAPD, chronic ambulatory peritoneal dialysis; CRRT, continuous renal replacement
therapies; HD, hemodialysis; GFR, glomerular filtration rate; D, decreasing individual doses;
I, increasing individual doses; NA, not applicable.