Drug Doses in Renal Failure

Drug Acarbose Acebutolol Acetaminophen Acetazolamide Acetohexamide Acetohydroxamic Acid Acetylsalicyclic Acid Acrivastine Aciclovir Adenosine Albuterol Alfentanil Allopurinol Alprazolam Alteplase (t-PA) Altretamine Amantadine Amikacin Amiloride Aminophylline Amiodarone Amitriptyline Amlodipine Amoxapine Amoxicillin Amphotericin Amphotericin B Colloidal Amphotericin B lipid Ampicillin Amrinone Dose Method D D I I I D I D D, I D D D D D D I D, I D D D D D D I I I I I D GFR > 50 (mL/min) 100% 100% q4h q6h Avoid 100% q4h 8 mg q12h 5 mg/kg q8h 100% 100% 100% 75% 100% 100% Unknown q24–48h 60–90% q12h 100% 100% 100% 100% 100% 100% q8h q24h q24h q24h q6h 100% GFR 10–50 (mL/min) Avoid 50% q6h q12h Avoid 100% q4–6h 8 mg q12–24h 5 mg/kg q12–24h 100% 100% 100% 50% 100% 100% Unknown q48–72h 30–70% q12–18h 50% 200–400 mg q12h 100% 100% 100% 100% q8–12h q24h q24h q24h q6–12h 100% GFR < 10 (mL/min) Avoid 30–50% q8h Avoid Avoid Avoid Avoid 8 mg q24h 2.5 mg/kg q24h 100% 100% 100% 33% 100% 100% Unknown q7d 20–30% q24–48h Avoid 200–300 mg q12h 100% 100% 100% 100% q24h q24–36h q24–36h q24–36h q12–24h 50–75% HD Unknown Dose as GFR < 10 Dose as GFR < 10 No data Avoid Unknown As normal GFR Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose post HD As normal GFR As normal GFR As normal GFR Dose as GFR < 10 Unknown As normal GFR No data Dose as GFR < 10 5 mg/kg post HD NA Dose as GFR < 10 As normal GFR As normal GFR As normal GFR Unknown Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose post HD No data CAPD Unknown Dose as GFR < 10 Dose as GFR < 10 No data Avoid Unknown As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR As normal GFR Dose as GFR < 10 Unknown As normal GFR No data Dose as GFR < 10 15–20 mg/L/day NA Dose as GFR < 10 As normal GFR As normal GFR As normal GFR Unknown 250 mg q8h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 No data CRRT Avoid Dose as GFR 10–50 As normal GFR Avoid Avoid Unknown As normal GFR Dose as GFR 10–50 3.5 mg/kg/day As normal GFR As normal GFR As normal GFR Dose as GFR 10–50 NA As normal GFR Unknown Dose as GFR 10–50 Dose as GFR 10–50 NA Dose as GFR 10–50 As normal GFR As normal GFR As normal GFR NA As normal GFR Dose as GFR 10–50 Dose for GFR 10–50 Dose as GFR 10–50 Dose as G FR 10–50 Dose as GFR 10–50

Internal Medicine / HD 2011 Page 1

I D D D D Internal Medicine / HD 2011 Page 2 .Drug Astemizole Atenolol Atovaquone Atracurium Auranofin Azathioprine Azithromycin Azlocillin Aztreonam Basiliximab Benazepril Betamethasone Betaxolol Bezafibrate Bisoprolol Bleomycin Bopindolol Bretylium Bromocriptine Brompheniramine Budesonide Bumetanide Bupropion Buspirone Busulfan Butorphanol Capreomycin Captopril Carbamazepine Carbidopa Carboplatin Carmustine Dose GFR > 50 Method (mL/min) D 100% D. I 100% q24h 100% D 100% D 3–6 mg q24h D 100% D 100% I q4–6h D 100% 100% 100% 100% 100% 70% 100% 100% 100% 100% 100% 100% 100% 100% 100% q24h 100% 100% 100% q24h 100% q8–12h 100% 100% 100% 100% GFR 10–50 (mL/min) 100% 100% q24h 100% 100% 3 mg q24h 75% 100% q6–8h 50–75% 100% 50–75% 100% 100% 50% q24–48h 100% 75% 100% 25–50% 100% 100% 100% 100% 100% q24h 100% 100% 75% q24h 75% q12–18h 100% 100% 50% 100% GFR < 10 (mL/min) 100% 50% q24h 100% 100% Avoid 50% 100% q8h 25% 100% 25–50% 100% 50% Avoid 50% 50% 100% 25% 100% 100% 100% 100% 100% q24h 100% 100% 50% q48h 50% q24h 100% 100% 25% 100% HD Unknown Dose as GFR < 10 As normal GFR As normal GFR Avoid As normal GFR No data Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose post HD As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 200 mg q72h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10    50% if anuric Unknown Unknown Dose as GFR < 10 Dose as GFR < 10 As normal GFR Unknown Dose as GFR < 10 As normal GFR CAPD Unknown Dose as GFR < 10 As normal GFR As normal GFR Avoid Dose as GFR < 10 No data Dose for GFR < 10 Dose for GFR < 10 As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 200 mg q72h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10    50% if anuric Unknown Unknown Dose as GFR < 10 Dose as GFR < 10 As normal GFR Unknown Dose as GFR < 10 As normal GFR CRRT NA As normal GFR As normal GFR As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 No data Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 As normal GFR As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR As normal GFR As normal GFR As normal GFR Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 NA As normal GFR Dose as GFR 10–50 As normal GFR Unknown Dose as GFR 10–50 As normal GFR D D D D D D D D D D D D D D D D I D.

25–1 g q12h 100% 100% 0.5 g q24h Dose post HD As normal GFR Dose post HD Dose as GFR < 10 Dose post HD 750 mg q24h CAPD As normal GFR 250 mg q8–12h 0.5 g q12h Dose for GFR < 10 200 mg q24h 0.0 g q12h Dose post HD 0.5–1.Drug Carvedilol Cefaclor Cefadroxil Cefamandole Cefazolin Cefepime Cefixime Cefmenoxime Cefmetazole Cefonicid Ceforanide Cefotaxime Cefotetan Cefoxitin Cefpodoxime Cefprozil Ceftazidime Ceftibuten Ceftizoxime Ceftriaxone Cefuroxime axetil (oral) Cefuroxime (iv) Dose Method D D I I I I D D.5–1.5–1 g q12–24h 100–200 mg q24–48h 50% q24h 0.5 g q8–12h GFR < 10 (mL/min) 100% 50% q24–48h q12h q24–48h q24–48h 50% 0.75 g q8h q24h 0. I I I D I I D.5–1 g q12–24h 50% 0.0 g post HD Dose as GFR < 10 Dose post HD 250–500 mg q24h +500 mg post HD 0.5 g/day 0.5–1 g q24h Dose as GFR < 10 0.5–1 g q12h Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR As normal GFR Dose as GFR 10–50 Internal Medicine / HD 2011 Page 3 . I I D I D D GFR > 50 (mL/min) 100% 100% q12h q6h q8h q12h 100% 1.5 g q24h 100% 250 mg q24h 750 mg q12h Dose post HD HD As normal GFR 250–500 mg q8h 0.0 g post HD 200 mg q24h Dose post HD 0.5–1.75 g q12h Dose as GFR < 10 Dose as GFR < 10 None 1 g q24h 1 g q24h 1 g q24h Dose as GFR < 10 Dose as GFR < 10 0.75–1.0 g post HD 1.0 g q8h q16h 0.0 g q24h As normal GFR Dose as GFR < 10 750 mg q24h CRRT As normal GFR As normal GFR As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Not recommended Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 1.5–1.0 g q12h 0.5–1 g q24–48h +1 g post HD Dose as GFR < 10 Dose as GFR < 10 Dose post HD 1 g post HD 400 mg post HD 0.1 g/day q24–48h 50% q8–12h 25% 0.0 g/day 1 g q12h 750 mg q12h Dose as GFR 10–50 As normal GFR Dose as GFR < 10 0.25–0.5–1.5–1.75 g q12h q48h 0.1 g–0.5–1 g q48h 25% 0.25–0.5 g q8h 100% 100% 100% GFR 10–50 (mL/min) 100% 50–100% q12–24h q6–8h q12h q16–24h 75% 0.5 g/day q12–24h 100% q8h 50% 1–2 g q8–24h 100% 50% q24h 0. I I D.0 g post HD 0.5–1.5 g/d q12h 100% q8h 100% 100% 100% 100% 100% 100% 0.75 g q12h Dose post HD Dose as GFR < 10 Dose post HD Dose as GFR < 10 0.

Drug Cephalexin Cephalothin Cephapirin Cephradine Cetirizine Chloralhydrate Chlorambucil Chloramphenicol Chlorazepate Chlordiazepoxide Chloroquine Chlorpheniramine Chlorpromazine Chlorpropamide Chlorthalidone Cholestyramine Cibenzoline Cidofovir Cilastin Cilazapril Cimetidine Cinoxacin Ciprofloxacin Cisapride Cisplatin Cladribine Clarithromycin Clavulanic acid Clindamycin Dose GFR > 50 Method (mL/min) I 250–500 mg q6h I I D D D D D D D D D D D I D D. I D D D D D D D D D q6h q6h 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% q12h 50–100% 100% 75% q24h 100% 100% 100% 100% 100% Unknown 100% 100% 100% GFR 10–50 (mL/min) 250–500 mg q8–12h q6–8h q6–8h 50% 100% Avoid 100% 100% 100% 100% 100% 100% 100% Avoid 100% 100% 100% q12h Avoid 50% 50% q24–48h 50% 50% 50–75% 50% 75% Unknown 75% 100% 100% GFR < 10 (mL/min) 250–500 mg q12–24h q12h q12h 25% 50% Avoid 100% 100% 100% 50% 50% 50% 100% Avoid Avoid 100% 66% q24h Avoid Avoid 10–25% q72h 25% Avoid 50% 50% 50% Unknown 50–75% 50–75% 100% HD Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose post dialysis Dose as GFR < 10 Avoid As normal GFR As normal GFR Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Avoid Avoid As normal GFR Dose as GFR < 10 No data Avoid Dose as GFR < 10 Dose as GFR < 10 Avoid 250 mg q12h Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose post HD As normal GFR CAPD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose for GFR < 10 Dose as GFR < 10 Avoid As normal GFR As normal GFR Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Avoid Avoid As normal GFR Dose as GFR < 10 No data Avoid Dose as GFR < 10 Dose as GFR < 10 Avoid 250 mg q8h Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 As normal GFR CRRT Dose as GFR 10–50 1 g q8h 1 g q8h As normal GFR As normal GFR Avoid As normal GFR As normal GFR NA As normal GFR As normal GFR Dose as GFR 10–50 As normal GFR Avoid NA As normal GFR Dose as GFR 10–50 Avoid Avoid Dose as GFR 10–50 Dose as GFR 10–50 Avoid 200 mg IV q12h 50–100% Dose as GFR 10–50 Unknown Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Internal Medicine / HD 2011 Page 4 . I D D D.

I D D D D I D D GFR > 50 (mL/min) 100% q6–12h 100% 100% 100% 100% 100% 100% 100% 100% q12h 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% q24h 100% 100% 100% 100% 100% q8h 100% 100% GFR 10–50 (mL/min) GFR < 10 (mL/min) HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR Unknown CAPD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 No data Unknown Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR Unknown CRRT No data Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 NA As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR NA Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Unknown As normal GFR Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 100% 100% q12–18h Avoid Start at lower dose and monitor effect 100% 100% 100% 100% 75% 50% 100% 50% 100% 100% 100% 100% 75–100% 50–75% q12–24h q24h 100% 100% 100% 100% 100% 50% 75% 50% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 25% 50% 50% 100% 50–75% 25–75% q36h 10–25% q48h 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% q12h q24–40h 100% 100% 50% 50% Internal Medicine / HD 2011 Page 5 .Drug Clofazimine Clofibrate Clomipramine Clonazepam Clonidine Codeine Colchicine Colestipol Cortisone Cyclophosphamide Cycloserine Cyclosporine Cytarabine Dapsone Daunorubicin Delavirdine Desferrioxamine Desipramine Dexamethasone Diazepam Diazoxide Diclofenac Dicloxacillin Didanosine Diflunisal Digitoxin Digoxin Dilevalol Diltiazem Diphenhydramine Dipyridamole Dirithromycin Disopyramide Dobutamine Doxacurium Dose Method I D D D D D D D D I D D D D D D D D D D I D D D.

5/24h Dose as GFR < 10 As normal GFR Dose as GFR < 10 CRRT As normal GFR As normal GFR As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR As normal GFR NA Dose as GFR 10–50 Dose as GFR 10–50 NA Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Internal Medicine / HD 2011 Page 6 .Drug Doxepin Doxorubicin Doxycycline Dyphylline Ebastine Enalapril Epirubicin Erythromycin Estazolam Etanercept Ethambutol Ethchlorvynol Ethionamide Ethosuximide Etodolac Etomidate Etoposide Famciclovir Famotidine Fazadinium Felodipine Fenoprofen Fentanyl Fexofenadine Flecainide Fleroxacin Fluconazole Flucytosine Fludarabine Flumazenil Flunarizine Dose Method D D D D D D D D D I D D D D D D I D D D D D I D D D I D D D GFR > 50 (mL/min) 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% q24h 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% q12h 100% 100% 100% q12h 100% 100% 100% GFR 10–50 (mL/min) 100% 100% 100% 50% 50% 75–100% 100% 100% 100% 100% q24–36h Avoid 100% 100% 100% 100% 75% q12–48h 50% 100% 100% 100% 75% q12–24h 75% 50% 100% q16h 75% 100% 100% GFR < 10 (mL/min) 100% 100% 100% 25% 50% 50% 100% 50–75% 100% 100% q48h Avoid 50% 100% 100% 100% 50% 50% q48h 20 mg q24h 100% 100% 100% 50% q24h 50% 50% 50% q24h 50% 100% 100% HD As normal GFR As normal GFR As normal GFR ⅓ dose Unknown Dose as GFR < 10 As normal GFR Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Unknown As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 400 mg post HD Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose post HD Dose as GFR < 10 As normal GFR Dose as GFR < 10 CAPD As normal GFR As normal GFR As normal GFR Unknown Unknown Dose as GFR < 10 As normal GFR Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 400 mg/24h Dose as GFR < 10 0.

Drug Fluoxetine Flurazepam Flurbiprofen Flutamide Fluvastatin Fluvoxamine Foscarnet Fosinopril Furosemide Gabapentin Gallamine Ganciclovir Gemfibrozil Gentamicin Glibornuride Gliclazide Glipizide Glyburide Gold Sodium Thiomalate Griseofulvin Guanabenz Guanadrel Guanethidine Guanfacine Haloperidol Heparin Hexobarbital Hydralazine Hydrocortisone Hydroxyurea Dose Method D D D D D D D D D D.5 mg/kg q24h Dose as GFR 10–50 Dose as GFR 10–50 Avoid Dose as GFR 10–50 Avoid Avoid Avoid As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Avoid Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR NA Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Avoid Avoid 1.25 mg/kg q24h 100% 30–70% q12h Unknown 20–40 mg/day 100% Avoid Avoid 100% 100% q12–24h q24h 100% 100% 100% 100% q8h 100% 50% 100% 20–30% q24–72h Unknown 20–40 mg/day Contraindicated Avoid Avoid 100% 100% q24–48h q24–36h 100% 100% 100% 100% q8–16h 100% 20% Internal Medicine / HD 2011 Page 7 . I D D D D D D D I I D D D D I D D GFR > 50 (mL/min) 100% 100% 100% 100% 100% 100% 28 mg/kg/q8h 100% 100% 400 mg q8h 75% 2.5–5 mg/kg q12h 100% 60–90% q8–12h Unknown 100% 100% Unknown 50% 100% 100% q12h q24h 100% 100% 100% 100% q8h 100% 100% GFR 10–50 (mL/min) 100% 100% 100% 100% 100% 100% 15 mg/kg/q8h 100% 100% 300 mg q12–24h GFR < 10 (mL/min) 100% 100% 100% 100% 50% 100% 6 mg/kg/q8h 75–100% 100% 300 mg q48h HD Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 As normal GFR 300 mg load then 200 mg post HD NA Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose post HD Unknown Dose as GFR < 10 Dose as GFR < 10 Avoid Dose as GFR < 10 As normal GFR Unknown Unknown Unknown Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 CAPD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 NA Dose as GFR < 10 Dose as GFR < 10 3–4 mg/L/day Unknown Dose as GFR < 10 Dose as GFR < 10 Avoid Dose as GFR < 10 As normal GFR Unknown Unknown Unknown Dose as GFR < 10 Dose as GFR < 10 As normal GFR Unknown Dose as GFR < 10 As normal GFR Dose as GFR < 10 CRRT Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR As normal GFR NA Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 2. I D I D D.25–2.5 mg/kg q24h 1.

15 mg/kg/h 100% 100% GFR 10–50 (mL/min) 100% Unknown 75% 100% 50% 100% 100% 100% 50% 100% No data Variable 100% 100% 100% 100% 100% 30–70% q12h 100% 100% 100% 100% 50% 100% 50–150 mg qd 100% 100% 50% bolus 15–30% 100% 50% GFR < 10 (mL/min) 100% Unknown 50% 50% 25% 100% 50% 100% 25% 100% No data Variable 100% 75% 100% 100 100% 20–30% q24–48h 100% 100% 100% 100% 50% 100% 25 mg qd 100% 100% Avoid 100% 25–50% HD As normal GFR Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose post HD As normal GFR Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 No data Variable As normal GFR Dose as GFR < 10 Dose post HD As normal GFR Dose post HD As normal GFR As normal GFR ⅔ normal dose Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose post HD Dose as GFR < 10 As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 CAPD As normal GFR Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 No data Variable As normal GFR Dose as GFR < 10 As normal GFR As normal GFR As normal GFR 15–20 mg/L/day Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 CRRT Dose as GFR 10–50 Unknown Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR NA Dose as GFR 10–50 NA Dose as GFR 10–50 No data Variable As normal GFR As normal GFR As normal GFR As normal GFR As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR 50% bolus 15% As normal GFR Dose as GFR 10–50 D D Internal Medicine / HD 2011 Page 8 . I D D D D D D D.4 mg/kg bolus 0.Drug Ibuprofen Idarubicin Ifosfamide Iloprost Imipenem Imipramine Indapamide Indinavir Indobufen Indomethacin Infliximab Insulin (soluble) Ipratropium Isoniazid Isosorbide Isradipine Itraconazole Kanamycin Ketamine Ketanserin Ketoconazole Ketoprofen Ketorolac Labetolol Lamivudine Lamotrigine Lansoprazole Lepirudin Levodopa Levofloxacin Dose GFR > 50 Method (mL/min) D 100% Unknown D 100% D 100% D 100% D D D D D D D D D D D. I D D 100% 100% 100% 100% 100% 100% Variable 100% 100% 100% 100% 100% 60–90% q8–12h 100% 100% 100% 100% 100% 100% 100% 100% 100% 0.

Drug Lincomycin Linezolid Lisinopril Lispro Insulin Lithium carbonate Lomefloxacin Loracarbef Lorazepam Losartan Lovastatin LMW Heparin Maprotiline Meclofenamic acid Mefenamic acid Mefloquine Melphalan Meperidine Meprobamate Meropenem Metaproterenol Metformin Methadone Methenamine Mandelate Methicillin Methimazole Methotrexate Methyldopa Methylprednisolone Metoclopramide Dose GFR > 50 Method (mL/min) I q6h D 100% D D D D I D D D D D D D D D I D. I D D D D I D D I D D 100% Variable 100% 100% q12h 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% q6h 500 mg q6h 100% 50% 100% 100% q4–6h 100% 100% q8h 100% 100% GFR 10–50 (mL/min) q6–12h 100% 50–75% Variable 50–75% 50–75% q24h 100% 100% 100% Prophylactic dose only 100% 100% 100% 100% 75% 75% q9–12h 250–500 mg q12h 100% Avoid 100% Avoid q6–8h 100% 50% q8–12h 100% 75% GFR < 10 (mL/min) q12–24h 100% Caution 25–50% Variable 25–50% 50% q3–5d 100% 100% 100% only 100% 100% 50% 100% 50% 50% q12–18h 250–500 mg q24h 100% Avoid 50–75% Avoid q8–12h 100% Contraindicated q12–24h 100% 50% HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Variable Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose post HD As normal GFR titrate Unknown Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Avoid Dose as GFR < 10 Dose as GFR < 10 Dose post HD Unknown Avoid Dose as GFR < 10 NA Dose as GFR < 10 Unknown Contraindicated Dose as GFR < 10 Dose post HD As normal GFR Dose post HD Dose as GFR < 10 CAPD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Variable Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR titrate Unknown Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Avoid Dose as GFR < 10 Dose as GFR < 10 Unknown Avoid Dose as GFR < 10 NA Dose as GFR < 10 Unknown Contraindicated Dose as GFR < 10 As normal GFR Dose as GFR < 10 CRRT NA Dose as GFR 10–50 Dose as GFR 10–50 Variable Dose as GFR 10–50 NA Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Dose for GFR Dose as GFR 10–50 NA Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Avoid NA Dose as GFR 10–50 Dose as GFR 10–50 Avoid As normal GFR NA Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR 50–75% Internal Medicine / HD 2011 Page 9 .

5–10 mg q8h Avoid 50 to 75% 100% 100% 75% 100% 50% 100% 50% q24–48h 50–100% 100% 75% 25% 100% Avoid 100% 100% 100% 100% No data 25% 10% q24h HD As normal GFR Dose as GFR < 10 As normal GFR Dose post HD Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 Unknown No data None Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Avoid As normal GFR Dose as GFR < 10 Unknown Dose as GFR < 10 No data Dose as GFR < 10 2 mg/kg post each HD session CAPD As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 Unknown No data None Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Avoid As normal GFR Dose as GFR < 10 Unknown Dose as GFR < 10 No data Dose as GFR < 10 IV: 2 mg/kg q48h IP: 7.Drug Metolazone Metoprolol Metronidazole Mexiletine Mezlocillin Miconazole Midazolam Midodrine Miglitol Milrinone Minocycline Minoxidil Mitomycin C Mitoxantrone Mivacurium Moricizine Morphine Moxalactam Mycophenolate mofetil Nabumetone N-Acetylcysteine Nadolol Nafcillin Nalidixic acid Naloxone Naproxen Nefazodone Nefopam Nelfinavir Neostigmine Netilmicin Dose GFR > 50 Method (mL/min) D 100% D 100% D 100% q8–12h D I D D D D D D D D D D D I D D D D D D D D D D D D.5–10 mg/LPE CRRT As normal GFR Dose as GFR 10–50 As normal GFR As normal GFR Dose as GFR 10–50 As normal GFR As normal GFR Dose as GFR 10–50 Avoid Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 100% Dose as GFR 10–50 Dose as GFR 10–50 Avoid As normal GFR Dose as GFR 10–50 NA Dose as GFR 10–50 No data Dose as GFR 10–50 Dose as GFR 10–50 Internal Medicine / HD 2011 Page 10 . I 100% q4–6h 100% 100% 5–10 mg q8h 50% 100% 100% 100% 100% 100% 100% 100% 100% q8–12h 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% No data 100% 50–90% q8–12h GFR 10–50 (mL/min) 100% 100% 100% q8–12h 100% q6–8h 100% 100% 5–10 mg q8h Avoid 100% 100% 100% 100% 100% 50% 100% 75% q12–24h 50–100% 100% 100% 50% 100% Avoid 100% 100% 100% 100% No data 50% 20–60% q24h GFR < 10 (mL/min) 100% 100% 100% q12h 50–75% q8h 100% 50% 2.

Drug Nicardipine Nicotinic acid Nifedipine Nimodipine Nisoldipine Nitrazepam Nitrofurantoin Nitroglycerine Nitroprusside Nitrosoureas Nizatidine Norfloxacin Nortriptyline Ofloxacin Omeprazole Ondansetron Orphenadrine Oxaprozin Oxatomide Oxazepam Oxcarbazepine Paclitaxel Pancuronium Paroxetine (PAS) Penbutolol Penicillamine Penicillin G Penicillin VK Pentamidine Pentazocine Pentobarbital Pentopril Dose Method D D D D D D D D D D D I D D D D D D D D D D D D D D D D D I D D D GFR > 50 (mL/min) 100% 100% 100% 100% 100% 100% Avoid 100% 100% 100% 75% q12h 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% q24h 100% 100% 100% GFR 10–50 (mL/min) 100% 50% 100% 100% 100% 100% Contraindicated 100% 100% 75% 50% q12–24h 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 50% 50–75% 50–75% 100% Avoid 75% 100% q24–36h 75% 100% 50–75% GFR < 10 (mL/min) 100% 25% 100% 100% 100% 100% Contraindicated 100% 100% 25–50% 25% Avoid 100% 25% 100% 100% 100% 100% 100% 75% 100% 100% Avoid 50% 50% 100% Avoid 20–50% 100% q48h 50% 100% 50% HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Contraindicated No data Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 NA As normal GFR Dose as GFR < 10 As normal GFR As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose after dialysis Dose as GFR < 10 weekly post HD Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 CAPD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Contraindicated No data Dose as GFR < 10 Unknown Dose as GFR < 10 NA As normal GFR Dose as GFR < 10 As normal GFR As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Avoid Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Unknown Dose as GFR < 10 CRRT Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR As normal GFR Contraindicated Dose as GFR 10–50 Dose as GFR 10–50 Unknown Dose as GFR 10–50 NA As normal GFR Dose as GFR 10–50 As normal GFR As normal GFR As normal GFR Dose as GFR 10–50 NA Dose as GFR 10–50 Unknown Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Avoid Dose as GFR 10–50 NA Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Internal Medicine / HD 2011 Page 11 .

Drug Pefloxacin Perindopril Phenelzine Phenobarbital Phenylbutazone Phenytoin Pindolol Pioglitazone Pipecuronium Piperacillin Piretanide Piroxicam Plicamycin Pravastatin Prazepam Prazosin Prednisolone Prednisone Pregabalin Primaquine Primidone Probenecid Probucol Procainamide Promethazine Propafenone Propofol Propoxyphene Propranolol Propylthiouracil Protryptyline Pyrazinimide Dose Method D D D I D D D D D I D D D D D D D D D GFR > 50 (mL/min) 100% 100% 100% q8–12h 100% 100% 100% 100% 100% q4–6h 100% 100% 100% 100% 100% 100% 100% 100% 100% q8–12h 100% q8h 100% 100% q4h 100% 100% 100% 100% 100% 100% 100% 100% GFR 10–50 (mL/min) 100% 75% 100% q8–12h 100% 100% 100% 100% 50% q6–8h 100% 100% 75% 100% 100% 100% 100% 100% 50% q8–12h 100% q8–12h Avoid 100% q6–12h 100% 100% 100% 100% 100% 75% 100% As normal GFR GFR < 10 (mL/min) 100% 50% 100% q12–16h 100% 100% 100% 100% with caution 25% q8h 100% 100% 50% 100% 100% 100% 100% 100% 25% q24h Extra dose post HD 100% q12–24h Avoid 100% Avoid 100% 100% 100% Avoid 100% 50% 100% As normal GFR HD Dose as GFR < 10 25–50% As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR caution Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 Unknown As normal GFR Unknown As normal GFR As normal GFR Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 ⅓ dose Avoid Unknown Avoid As normal GFR Dose as GFR < 10 As normal GFR Avoid Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR CAPD Dose as GFR < 10 Unknown As normal GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal GFR caution Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown As normal GFR Unknown As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Avoid Unknown Avoid As normal GFR Dose as GFR < 10 As normal GFR Avoid Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR CRRT Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR As normal GFR caution Dose as GFR 10–50 Dose as GFR 10–50 NA Dose as GFR 10–50 Unknown As normal GFR NA As normal GFR As normal GFR Dose as GFR 10–50 No data Dose as GFR 10–50 Unknown Avoid Dose as GFR 10–50 Avoid As normal GFR Dose as GFR 10–50 As normal GFR NA Dose as GFR 10–50 Dose as GFR 10–50 NA As normal GFR I D D I D D D D D D D D Internal Medicine / HD 2011 Page 12 .

Drug Pyrimethamine Quazepam Quinapril Quinidine Quinine Ramipril Ranitidine Ribavirin Rifabutin Rifampin Ritonavir Rituximab Rosiglitazone Saquinavir Secobarbital Sertraline Simvastatin Sodium valproate Sotalol Sparfloxacin Spectinomycin Spironolactone Stavudine Streptokinase Streptomycin Streptozotocin Succinylcholine Sufentanil Sulbactam Sulfamethoxazole Sulfinpyrazone Dose Method D D D D I D D D GFR > 50 (mL/min) 100% Unknown 100% 100% q8h 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% q6–12h 100% 100% q24h 100% 100% 100% q6–8h q12h 100% GFR 10–50 (mL/min) 100% Unknown 75–100% 100% q8–12h 50–75% 100% 100% 100% 50–100% 100% caution 100% 100% 100% 100% 100% 100% 25–50% 50–75% 100% q12–24h 50% q12–24h 100% q24–72h 75% 100% 100% q12–24h q18h 100% GFR < 10 (mL/min) 100% Unknown 50% 100% q24h 25–50% 50% 50% 100% 50–100% 100% caution 100% 100% 100% 100% 10 mg q24h 100% Avoid 50% q48h 100% Avoid 50% q24h 100% q72–96h 50% 100% 100% q24–48h q24h Avoid HD As normal GFR Unknown Dose as GFR 10–50 Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 As normal GFR caution As normal GFR As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose post HD As normal GFR 750 mg 2–3/week Unknown Unknown Unknown Dose as GFR < 10 Dose post HD 1 g after dialysis None CAPD As normal GFR Unknown Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR caution As normal GFR As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 No data Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR 20–40 mg/L/day Unknown Unknown Unknown 0. I D I D. I D I D D D I I D Internal Medicine / HD 2011 Page 13 .75–1.5 g/day 1 g/day None CRRT As normal GFR NA Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR As normal GFR caution As normal GFR As normal GFR NA As normal GFR As normal GFR As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Avoid Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 Unknown Dose as GFR 10–50 Dose as GFR 10–50 750 mg q12h Dose as GFR 10–50 Dose as GFR 10–50 D D D D D D D D.

I 1–2 g q4h D 100% 100% D 100% D. I 60–90% q8–12h D 100% D 100% D 100% D 100% D 75% D 100% D 100% D 50% D Unknown D 100% D 100% I q12h D 100% D Unknown I q8h I q12h GFR 10–50 (mL/min) 50–100% 30% 100% 100% 75% q48–72h 100% 100% 100% 50% 100% q12–24h 100% 100% 1–2 g q8h 100% 100% 100% 30–70% q12h 100% 100% 100% 50% 50% 100% 50–100 mg q6–12h 25% Unknown 100% 100% q12h 100% Unknown q8–12h 50% q18h GFR < 10 (mL/min) 50–100% 10% 100% 100% 50% q72h 100% 100% 100% Avoid 100% q24h Avoid 75% 1–2 g q12h 100% 100% 100% 20–30% q24–48h 100% 100% 100% 25% 25% 100% 50 mg q12h 10% Unknown Avoid/50% 100% Avoid 100% Unknown q12–24h 50% q24h HD Dose as GFR < 10 Unknown As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 NA 3 g after dialysis Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 ⅔ normal dose Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 No data Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 As normal GFR Avoid Dose as GFR < 10 Unknown Unknown Dose as GFR < 10 CAPD Dose as GFR < 10 Unknown As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 As normal GFR Dose as GFR < 10 Dose as GFR < 10 NA Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 3–4 mg/L/day Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 No data Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 As normal GFR Avoid Dose as GFR < 10 Unknown Unknown Dose as GFR < 10 CRRT Dose as GFR 10–50 Unknown As normal GFR As normal GFR Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 As normal GFR Dose as GFR 10–50 NA NA Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Dose as GFR 10–50 Avoid Avoid Dose as GFR 10–50 Dose as GFR 10–50 No data NA Dose as GFR 10–50 Dose as GFR 10–50 NA Dose as GFR 10–50 As normal GFR Avoid NA Unknown Dose as GFR 10–50 Dose as GFR 10–50 Internal Medicine / HD 2011 Page 14 .Drug Sulindac Sulotroban Tacrolimus Tamoxifen Tazobactam Teicoplanin Temazepam Teniposide Terazosin Terbutaline Terfenadine Tetracycline Thiazides Thiopental Ticarcillin Ticlopidine Tigecycline Timolol Tobramycin Tolazamide Tolbutamide Tolmetin Topiramate Topotecan Torsemide Tramadol Tranexamic acid Tranylcypromine Trazodone Triamcinolone Triamterene Triazolam Trihexyphenidyl Trimethadione Trimethoprim Dose GFR > 50 Method (mL/min) D 100% D 50% 100% D 100% D 100% I q24h D 100% D 100% D 100% D 100% D 100% I q8–12h D 100% D 100% D.

continuous renal replacement therapies. HD. I. CRRT.Drug Trimetrexate Trimipramine Tripelennamine Triprolidine Tubocurarine Urokinase Valganciclovir Vancomycin Vecuronium Venlafaxine Verapamil Vidarabine No data No data No data Dose as GFR < 10 Dose as GFR < 10 NA Unknown Unknown NA Unknown Unknown NA Unknown Unknown Dose as GFR 10–50 As normal GFR As normal GFR As normal GFR Avoid Avoid 450 mg q48h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10–50 As normal GFR As normal GFR As normal GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10–50 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10–50 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10–50 Infuse post HD Vigabatrin D 100% 50% 25% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10–50 Vinblastine D 100% 100% 100% 100% 2–3/week As normal GFR As normal GFR Dose post HD Vincristine D 100% 100% 100% As normal GFR As normal GFR As normal GFR Vinorelbine D 100% 100% 100% As normal GFR As normal GFR As normal GFR Warfarin D 100% 100% 100% As normal GFR As normal GFR As normal GFR Zafirlukast D 100% 100% 100% As normal GFR As normal GFR As normal GFR Zalcitabine I 100% q12h q24h Dose as GFR < 10 No data Dose as GFR 10–50 Dose post HD Zidovudine (AZT) D. decreasing individual doses. GFR. I D D D D GFR > 50 (mL/min) 100% 100% Unknown Unknown 75% 100% 50–100% 500 mg q6–12h 100% 100% 100% 100% GFR 10–50 (mL/min) 50–100% 100% Unknown Unknown 50% 100% 450 mg q24–48h 500 mg q12–48h 100% 50% 100% 100% GFR < 10 (mL/min) Avoid 100% Unknown Unknown Avoid 100% 450 mg BiW 500 mg q48–96h 100% 50% 100% 75% HD CAPD CRRT Internal Medicine / HD 2011 Page 15 . D. NA. increasing individual doses. glomerular filtration rate. I 100% q8h 100% q8h 50% q12h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10–50 Zileuton 100% 100% 100% Dose as GFR < 10 Unknown Dose as GFR 10–50 CAPD. chronic ambulatory peritoneal dialysis. hemodialysis. not applicable Dose Method D D D D D D D D.

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