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 Acarbose

Acebutolol D D 100% 100% Avoid 50% Avoid 30–50% Unknown Dose as GFR < 10 Dose as GFR < 10 No data Avoid Unknown

CAPD Unknown Dose as GFR < 10 Dose as GFR < 10 No data Avoid Unknown

CRRT Avoid Dose as GFR 10– 50 As normal GFR Avoid Avoid Unknown

Acetaminoph I en Acetazolamid I e Acetohexami I de Acetohydroxa D mic Acid Acetylsalicycl I ic Acid

q4h q6h Avoid 100% q4h

q6h q12h Avoid 100% q4–6h

q8h Avoid Avoid Avoid Avoid

As normal As normal As normal GFR GFR GFR Dose post HD

Acrivastine

D

8 mg q12h 5 mg/kg q8h

8 mg q12– 8 mg q24h Dose as 24h GFR < 10 5 mg/kg q12–24h 2.5 mg/kg q24h Dose as GFR < 10 Dose post HD

Dose as GFR < 10 Dose as GFR < 10

Dose as GFR 10– 50 3.5 mg/kg/day

Aciclovir

D, I

Adenosine Albuterol Alfentanil Allopurinol

D D D D

100% 100% 100% 75%

100% 100% 100% 50%

100% 100% 100% 33%

As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Unknown Dose as GFR < 10 Unknown Dose as GFR 10– 50 NA

Alprazolam Alteplase (tPA)

D

100% 100%

100% 100%

100% 100%

As normal As normal As normal GFR GFR GFR

Drug Altretamine Amantadine

GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D I Unkno Unknown wn q24– 48h 60– 90% q12h 100% 100% q48–72h Unknown q7d No data Dose as GFR < 10 5 mg/kg post HD NA Dose as GFR < 10

CAPD No data Dose as GFR < 10 15–20 mg/L/day NA Dose as GFR < 10

CRRT Unknown Dose as GFR 10– 50 Dose as GFR 10– 50 NA Dose as GFR 10– 50

Amikacin

D, I

30–70% q12–18h 50% 200–400 mg q12h 100% 100% 100% 100% q8–12h

20–30% q24–48h Avoid 200–300 mg q12h 100% 100% 100% 100% q24h

Amiloride

D

Aminophyllin D e Amiodarone D

100% 100% 100% 100% q8h

As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Unknown Dose as GFR < 10 Dose post HD Unknown 250 mg q8h NA As normal GFR

Amitriptyline D Amlodipine Amoxapine Amoxicillin D D I

Amphotericin I

q24h

q24h

q24–36h

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 as GFR 10– 50 Dose for GFR 10– 50 Dose as GFR 10– 50 Dose as G FR 10–50

Amphotericin I B Colloidal Amphotericin I B lipid Ampicillin I

q24h

q24h

q24–36h

q24h

q24h

q24–36h

q6h

q6–12h

q12–24h

Amrinone

D

100%

100%

50–75%

No data

No data

Dose as GFR 10–

Drug Anistreplase

GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D 100% 100% 100% Unknown

CAPD Unknown

CRRT 50 Dose as GFR 10– 50 NA As normal GFR

Astemizole Atenolol Atovaquone Atracurium Auranofin

D D, I

100% 100% q24h 100%

100% 100% q24h 100% 100%

100%

Unknown

Unknown Dose as GFR < 10

50% q24h Dose as GFR < 10 100% 100%

As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Avoid Avoid Dose as GFR 10– 50 Dose as GFR 10– 50 No data Dose as GFR 10– 50

D D

100%

3–6 mg 3 mg q24h Avoid q24h 100% 75% 50%

Azathioprine

D

As normal Dose as GFR GFR < 10 No data Dose as GFR < 10 Dose post HD No data Dose for GFR < 10

Azithromycin D Azlocillin I

100% q4–6h

100% q6–8h

100% q8h

Aztreonam

D

100%

50–75%

25%

Dose as GFR < 10 Dose post HD

Dose for GFR < 10

Dose as GFR 10– 50

Basiliximab Benazepril D

100% 100%

100% 50–75%

100% 25–50%

As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50

Betamethason D e Betaxolol D

100% 100%

100% 100%

100% 50%

As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR

Drug Bezafibrate GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D 70% 50% q24– Avoid 48h 100% 50% 200 mg q72h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 CAPD 200 mg q72h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 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 Dose as GFR 10– 50 Bisoprolol D 100% Bleomycin D 100% 75% 50% Bopindolol D 100% 100% 100% Bretylium D 100% 25–50% 25% Bromocriptin D e Bromphenira D mine Budesonide Bumetanide Bupropion D D D 100% 100% 100% 100% 100% q24h 100% 100% 100% 100% 100% 100% q24h 100% 100% 100% 100% 100% 100% q24h 100% As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 As normal GFR Buspirone D 50% if anuric Busulfan D 100% 100% 100% Unknown 50% if anuric Unknown Dose as GFR 10– 50 NA As normal GFR Butorphanol D 100% q24h 75% q24h 50% q48h Unknown Dose as GFR < 10 Unknown Dose as GFR < 10 Capreomycin I .

5 g/day 0.0 g q12h Dose post HD 250 mg q8–12h 0.0 g post HD 0.5 g q12h Dose as GFR 10– 50 Dose for GFR < 10 200 mg q24h Not recommen ded Dose as GFR 10– 50 Cefepime I q12h q16–24h q24–48h Cefixime D 100% 75% 50% Cefmenoxime D.5–1. I 100% 75% q12– 50% q24h Dose as q8–12h 18h GFR < 10 100% 100% 100% 100% 100% 50% 100% 100% 25% CAPD Dose as GFR < 10 CRRT Dose as GFR 10– 50 Carbamazepi D ne Carbidopa Carboplatin D D As normal As normal As normal GFR GFR GFR Unknown Dose as GFR < 10 Unknown Dose as GFR < 10 Unknown Dose as GFR 10– 50 Carmustine Carteolol D D 100% 100% 100% 50% 100% 25% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Carvedilol Cefaclor Cefadroxil D D I 100% 100% q12h q6h 100% 50–100% q12–24h q6–8h 100% 50% q24–48h q12h As normal As normal As normal GFR GFR GFR 250–500 mg q8h 0.75 g q12h Dose as GFR 10– .0 g post HD 1.75 g q12h 0.75 g q8h 0.0 g q8h 0.75 g q12h 0.0 g post HD 200 mg q24h Dose post HD 0.5–1.5–1.5–1.Drug Captopril GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D. I 1.0 g q12h As normal GFR As normal GFR Dose as GFR 10– 50 Cefamandole I Cefazolin I q8h q12h q24–48h 0.

1 g/day Dose as GFR < 10 0.5–1 g q24–48h +1 g post HD 1 g q24h Dose as GFR 10– 50 Cefpodoxime I 100% 100% 100–200 mg q24–48h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR < 10 Cefprozil D.5–1 g q12–24h 50% 0.5–1 g q12h Dose as GFR 10– .5 g/d 0.5–1.5–1 g q12–24h 0. I 0.5–1 g q24h Dose as GFR < 10 0.5–1 g q48h 25% 1 g post HD 400 mg post HD 0.0 g post HD Dose as GFR < 10 Dose post HD Dose as GFR < 10 None 1 g q24h Dose as GFR 10– 50 1.Drug GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD Dose post HD CAPD CRRT 50 Cefmetazole I q16h q24h q48h Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR 10– 50 Cefonicid D.0 g/day 1 g q12h Ceforanide Cefotaxime I I q24–48h 100% q8h 50% q8– 12h Cefotetan D 100% 50% 25% 250–500 mg q24h +500 mg post HD 1 g q24h 750 mg q12h Cefoxitin I 100% 1–2 g q8– 24h 0.5 g/day q12h 100% q8h q12–24h 0.1 g–0. I 100% 50% q24h 50% q24h Dose as GFR < 10 Dose post HD Ceftazidime Ceftibuten I D 100% 100% 0.

5 g 0.25–1 g g q8h q12h CAPD CRRT 50 Dose as GFR 10– 50 0.5 g 0.25–0.5–1.75–1.0 g q24h q24h q24h Dose post HD Ceftriaxone D 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose post HD Cefuroxime axetil (oral) D 100% 100% 250 mg q24h Dose as GFR < 10 Dose post HD Dose as GFR < 10 As normal GFR Cefuroxime (iv) 100% 0.5 0.25–0.Drug Ceftizoxime GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD I 0.5 g 750 mg q8–12h q12h Dose post HD 750 mg q24h 750 mg q24h Dose as GFR 10– 50 Celiprolol Cephalexin D I 100% 100% 75% Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR 10– 50 250– 250–500 250–500 500 mg mg q8–12h mg q6h q12–24h Cephalothin I q6h q6–8h q12h Dose as GFR < 10 1 g q8h Cephapirin I q6h q6–8h q12h Dose as GFR < 10 Dose post HD Dose as GFR < 10 1 g q8h Cephradine D 100% 50% 25% Dose as GFR < 10 Dose post Dose for GFR < 10 As normal GFR .5–1.

I 100% 50% 100% 100% 100% q12h 50– 100% 100% 75% q24h 100% 100% Avoid 100% 100% 100% q12h Avoid 50% 100% Avoid Avoid 100% As normal As normal As normal GFR GFR GFR Avoid Avoid Avoid Avoid Avoid NA As normal As normal As normal GFR GFR GFR Dose as GFR < 10 No data Avoid Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Avoid Avoid Dose as GFR 10– 50 Dose as GFR 10– 50 66% q24h Dose as GFR < 10 Avoid Avoid No data Avoid Dose as GFR < 10 Dose as GFR < 10 Cidofovir Cilastin Cilazapril D D D. I 50% q24– 10–25% 48h q72h 50% 25% Cimetidine D .Drug Cetirizine GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD dialysis D 100% 100% 100% 100% 100% 100% 100% 100% 100% Avoid 100% 100% 100% 100% 100% 100% 50% Avoid 100% 100% 100% 50% 50% 50% Dose as GFR < 10 Avoid CAPD Dose as GFR < 10 Avoid CRRT As normal GFR Avoid Chloralhydrat D e Chlorambucil D Chlorampheni D col Chlorazepate D Chlordiazepo D xide Chloroquine D As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 NA As normal GFR As normal GFR Dose as GFR 10– 50 Chlorphenira D mine Chlorpromazi D ne Chlorpropami D de Chlorthalidon I e Cholestyrami D ne Cibenzoline D.

Drug Cinoxacin GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D 100% 100% 100% 100% 50% 50–75% 50% 75% Avoid 50% 50% 50% Avoid 250 mg q12h Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose post HD CAPD Avoid 250 mg q8h Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 CRRT Avoid 200 mg IV q12h 50–100% Dose as GFR 10– 50 Unknown Dose as GFR 10– 50 Ciprofloxacin D Cisapride Cisplatin D D Cladribine D Unkno Unknown wn 100% 75% Unknown 50–75% Clarithromyci D n Clavulanic acid D 100% 100% 50–75% Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR 10– 50 Clindamycin Clodronate D D 100% 100% 100% 50% 100% 25% As normal As normal As normal GFR GFR 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 Dose as GFR < 10 Dose as GFR 10– 50 No data Dose as GFR 10– 50 Dose as GFR 10– 50 Clofazimine Clofibrate I 100% 100% 100% Avoid q6–12h q12–18h Clomipramin D e Clonazepam Clonidine Codeine D D D 100% Start at lower dose and Dose as monitor effect GFR < 10 100% 100% 75% 100% 100% 50% 100% 100% 100% As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Dose as Dose as Dose as .

Drug GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD GFR < 10 CAPD GFR < 10 Dose as GFR < 10 CRRT GFR 10– 50 Dose as GFR 10– 50 Colchicine D 100% 100% 50% Dose as GFR < 10 Colestipol Cortisone D D 100% 100% 100% 100% 100% 75–100% 100% 100% 50–75% As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Dose as GFR 10– 50 Cyclophospha D mide Cycloserine I q12h q12–24h q24h Cyclosporine D Cytarabine D 100% 100% 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 No data 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 Dapsone 100% 100% 50% Daunorubicin D 100% 75% 50% Delavirdine 100% 100% 100% Desferrioxam D ine Desipramine D 100% 100% 50% Unknown 100% 100% 100% 100% 100% 100% 100% 100% 100% Dose as GFR < 10 Dose as GFR < 10 Dexamethaso D ne Diazepam D As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 .

I 100% q24h 100% 100% 100% 25–75% q36h 100% 100% 100% 10–25% q48h 100% 100% 100% Dilevalol Diltiazem Diphenhydra mine D D D As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Dipyridamole D Dirithromycin 100% 100% 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Dose as GFR 10– 50 Disopyramide I q8h q12h q24–40h Dobutamine Doxacurium D D 100% 100% 100% 50% 100% 50% As normal As normal As normal GFR GFR GFR Unknown Unknown Dose as GFR 10– 50 .Drug Diazoxide GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D 100% 100% 100% Dose as GFR < 10 CAPD Dose as GFR < 10 CRRT Dose as GFR 10– 50 Diclofenac Dicloxacillin Didanosine D D I 100% 100% 100% 100% 100% 50% 100% 100% 25% As normal As normal As normal GFR GFR 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 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 NA Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Unknown Diflunisal D 100% 50% 50% Digitoxin D 100% 100% 50–75% Digoxin D.

Drug Doxazosin Doxepin Doxorubicin Doxycycline Dyphylline GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D D D D D 100% 100% 100% 100% 75% 100% 100% 100% 100% 50% 100% 100% 100% 100% 25% CAPD CRRT As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR ⅓ dose Unknown Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Ebastine D 100% 50% 50% Unknown Unknown Enalapril D 100% 75–100% 50% Dose as GFR < 10 Dose as GFR < 10 Epirubicin D 100% 100% 100% 100% 100% 100% 100% 100% 100% 50–75% 100% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 As normal GFR NA Dose as GFR 10– 50 Dose as GFR 10– 50 Erythromycin D Estazolam Etanercept D Ethambutol I q24h q24–36h q48h Ethchlorvynol D Ethionamide D 100% 100% Avoid 100% Avoid 50% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 NA Dose as GFR 10– 50 Ethosuximide D Etodolac D 100% 100% 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR As normal As normal Dose as .

Drug GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD GFR CAPD GFR CRRT GFR 10– 50 Etomidate Etoposide D D 100% 100% 100% 75% 100% 50% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Dose as GFR 10– 50 Famciclovir I 100% q12–48h 50% q48h Dose as GFR < 10 Dose post HD Famotidine D 100% 50% 20 mg q24h 100% Dose as GFR < 10 Unknown Dose as GFR < 10 Unknown Dose as GFR 10– 50 Dose as GFR 10– 50 Fazadinium D 100% 100% Felodipine Fenoprofen Fentanyl D D D 100% 100% 100% 100% 100% 75% 100% 100% 50% As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR 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 as GFR < 10 Dose as GFR < 10 400 mg/24h Dose as GFR < 10 Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 As normal GFR Fexofenadine I q12h q12–24h q24h Flecainide D 100% 75% 50% Fleroxacin D 100% 50% 50% Fluconazole D 100% 100% 50% .

5/24h CRRT Dose as GFR 10– 50 Fludarabine D 100% 75% 50% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Flumazenil Flunarizine D D 100% 100% 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Dose as GFR 10– 50 Fluorouracil D 100% 100% 100% Fluoxetine D 100% 100% 100% 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– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Flurazepam D 100% 100% 100% Flurbiprofen D 100% 100% 100% Flutamide Fluvastatin D D 100% 100% 100% 100% 100% 100% 100% 50% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 As normal GFR NA Dose as GFR 10– 50 Fluvoxamine D Foscarnet D 28 15 6 Dose as mg/kg/ mg/kg/q8h mg/kg/q8h GFR < 10 q8h Dose post HD .Drug Flucytosine GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD I q12h q16h q24h Dose as GFR < 10 Dose post HD CAPD 0.

I 60– 30–70% 90% q12h q8–12h 20–30% q24–72h Glibornuride Gliclazide D D Unkno Unknown wn 100% 20–40 mg/day 100% Unknown 20–40 mg/day Unknown Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Avoid Dose as GFR < 10 Avoid Dose as GFR 10– 50 Avoid Avoid Avoid Glipizide Glyburide D D 100% Contraindi Dose as cated GFR < 10 Avoid Avoid 100% Avoid Dose as GFR < 10 Unkno Avoid wn 50% 100% Avoid 100% Gold Sodium D Thiomalate Griseofulvin D As normal As normal As normal .25 mg/kg q24h Dose as GFR < 10 Dose post HD Dose as GFR < 10 Gemfibrozil D 100% 100% 100% Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 3–4 mg/L/day Dose as GFR 10– 50 Dose as GFR 10– 50 Gentamicin D.25–2.Drug Fosinopril GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D 100% 100% 75–100% Dose as GFR < 10 CAPD Dose as GFR < 10 CRRT Dose as GFR 10– 50 Furosemide Gabapentin D D.5 mg/kg q24h Ganciclovir I 2. I 100% 100% 100% 300 mg q48h As normal As normal As normal GFR GFR GFR 300 mg load then 200 mg post HD Dose as GFR < 10 Dose as GFR 10– 50 400 mg 300 mg q8h q12–24h Gallamine D 75% Avoid Avoid NA NA Dose as GFR 10– 50 2.5–5 mg/kg q12h 1.5 mg/kg q24h 1.

Drug Guanabenz GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD GFR D 100% 100% 100% Unknown CAPD GFR Unknown CRRT GFR Dose as GFR 10– 50 Dose as GFR 10– 50 Avoid Dose as GFR 10– 50 Dose as GFR 10– 50 Guanadrel I q12h q12–24h q24–48h Unknown Unknown Guanethidine I Guanfacine D q24h 100% q24h 100% q24–36h 100% Unknown Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Haloperidol D 100% 100% 100% Heparin Hexobarbital Hydralazine D D I 100% 100% q8h 100% 100% q8h 100% 100% q8–16h As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 NA Dose as GFR 10– 50 Hydrocortiso D ne Hydroxyurea D 100% 100% 100% 50% 100% 20% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 100% Dose as GFR < 10 100% Dose as GFR 10– 50 100% Hydroxyzine Ibuprofen D D 100% 100% Unknown 100% Unknown 100% As normal As normal Dose as GFR GFR GFR 10– 50 Unknown Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR 10– 50 Dose as GFR 10– 50 Idarubicin Ifosfamide D Unkno Unknown wn 100% 75% Unknown 50% Iloprost D 100% 100% 50% .

I 100% 100% 100% 100% 100 100% 20–30% q24–48h 100% As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR ⅔ normal dose Unknown 15–20 mg/L/day Unknown Dose as GFR 10– 50 Dose as 60– 30–70% 90% q12h q8–12h 100% 100% Ketamine D .Drug Imipenem GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D 100% 50% 25% Dose as GFR < 10 Dose post HD CAPD Dose as GFR < 10 CRRT Dose as GFR 10– 50 Imipramine Indapamide Indinavir D D 100% 100% 100% 100% 100% 100% 100% 50% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 No data Variable Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 No data Variable NA Dose as GFR 10– 50 NA Dose as GFR 10– 50 No data Variable Indobufen D 100% 100% 50% 100% 25% 100% Indomethacin D Infliximab Insulin (soluble) Ipratropium Isoniazid D D D 100% No data No data Variable 100% 75% Variabl Variable e 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose post HD Dose as GFR < 10 As normal GFR Isosorbide D 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose post HD Isradipine Itraconazole Kanamycin D D D.

Drug GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD CAPD CRRT GFR 10– 50 Ketanserin D 100% 100% 100% 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– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Ketoconazole D 100% 100% 100% Ketoprofen D 100% 100% 100% Ketorolac D 100% 50% 50% Labetolol Lamivudine D D. I 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR 10– 50 50–150 mg 25 mg qd qd Lamotrigine D 100% 100% 100% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Lansoprazole D Lepirudin 100% 0.4 mg/kg bolus 100% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 50% bolus 50% bolus Avoid 0.15 15–30% mg/kg/ h Levodopa D 100% 100% 100% 50% 100% 25–50% 15% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Dose as GFR 10– Levofloxacin D Lidocaine D 100% 100% 100% .

Drug Lincomycin Linezolid GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD I D q6h 100% q6–12h 100% q12–24h 100% Dose as GFR < 10 Dose as GFR < 10 CAPD Dose as GFR < 10 Dose as GFR < 10 CRRT 50 NA Dose as GFR 10– 50 Dose as GFR 10– 50 Variable Dose as GFR 10– 50 Caution Lisinopril D 100% 50–75% 25–50% Dose as GFR < 10 Variable Dose as GFR < 10 Dose post HD Lomefloxacin D Loracarbef I 100% q12h 50–75% q24h 50% q3–5d Dose as GFR < 10 Dose as GFR < 10 Dose post HD Lorazepam Losartan D D 100% 100% 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR 25 mg/24h 25 mg/24h Dose as and titrate and titrate GFR 10– 50 Unknown Unknown Dose as GFR < 10 Dose for GFR Dose as GFR 10– 50 NA Dose as GFR 10– Dose as GFR < 10 Dose as GFR < 10 NA Dose as GFR 10– 50 Dose as GFR < 10 Variable Dose as GFR < 10 Lispro Insulin D Lithium carbonate D Variabl Variable e 100% 50–75% Variable 25–50% Lovastatin Lowmolecularweight heparin Maprotiline D D 100% 100% 100% 100% Prophylact Prophylact Dose as ic dose ic dose GFR < 10 only only 100% 100% 100% 100% Unknown Dose as GFR < 10 D 100% 100% Unknown Dose as GFR < 10 Meclofenami D c acid .

Drug Mefenamic acid Mefloquine GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D 100% 100% 50% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Avoid Dose as GFR < 10 Dose as GFR < 10 Dose post HD CAPD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Avoid Dose as GFR < 10 Dose as GFR < 10 CRRT 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Avoid NA Dose as GFR 10– 50 100% 100% 100% Melphalan D 100% 75% 50% Meperidine D 100% q6h 75% q9–12h 50% q12–18h 250–500 mg q24h Meprobamate I Meropenem D. I 500 mg 250–500 q6h mg q12h Metaproteren D ol Metformin Methadone D D 100% 100% 100% Unknown Unknown Dose as GFR 10– 50 Avoid As normal GFR NA Dose as GFR 10– 50 Dose as GFR 10– 50 50% 100% 100% q4–6h Avoid 100% Avoid q6–8h Avoid 50–75% Avoid q8–12h Avoid Dose as GFR < 10 NA Dose as GFR < 10 Unknown Avoid Dose as GFR < 10 NA Dose as GFR < 10 Unknown Methenamine D Mandelate Methicillin I Methimazole D 100% 100% 100% Methotrexate D 100% 50% Contraindi Contraindi Contraindi Dose as cated cated cated GFR 10– 50 q12–24h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Methyldopa I q8h q8–12h .

5–10 mg Dose as q8h GFR < 10 Avoid Unknown Miglitol Milrinone 50 to 75% No data Minocycline D 100% 100% 100% None None .Drug GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD Dose post HD CAPD CRRT Methylpredni D solone 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose post HD Metocloprami D de Metocurine D 100% 75% 75% 50% 50% 50% Dose as GFR < 10 Unknown Dose as GFR < 10 Unknown 50–75% Dose as GFR 10– 50 Metolazone Metoprolol D D 100% 100% 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 As normal GFR Metronidazol D e 100% 100% q8– 100% q8–12h 12h q12h As normal Dose as GFR GFR < 10 Dose post HD Mexiletine Mezlocillin D I 100% q4–6h 100% q6–8h 50–75% q8h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 As normal GFR Dose as GFR 10– 50 Miconazole Midazolam Midodrine D D 100% 100% 100% 100% 100% 50% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown No data As normal GFR Dose as GFR 10– 50 Avoid Dose as GFR 10– 50 Dose as GFR 10– 5–10 5–10 mg mg q8h q8h D D 50% 100% Avoid 100% 2.

Drug Minoxidil GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D 100% 100% 100% Dose as GFR < 10 Dose as GFR < 10 Unknown CAPD Dose as GFR < 10 Dose as GFR < 10 Unknown CRRT 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 Mitomycin C D Mitoxantrone D 100% 100% 100% 100% 75% 100% Mivacurium D 100% 50% 50% 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 Moricizine D 100% 100% 100% Morphine D 100% 75% 50% Moxalactam I q8–12h q12–24h q24–48h Mycophenola D te mofetil Nabumetone D 100% 100% 50–100% 100% 50–100% 100% 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 As normal GFR Dose as GFR 10– 50 100% ND Acetylcystein e Nadolol D 100% 100% 75% 100% 50% 25% Dose as GFR 10– 50 Nafcillin D 100% 100% 100% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 .

5–10 mg/LPE Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 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 NA Dose as GFR 10– 50 No data Dose as GFR 10– 50 Dose as GFR 10– 50 Nefazodone Nefopam D D 100% 100% 100% 100% 100% 100% Nelfinavir Neostigmine D No data 100% No data 50% No data 25% Netilmicin D. I 50– 20–60% 90% q24h q8–12h 10% q24h 2 mg/kg post each HD session Nevirapine D 100% 100% 100% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Nicardipine D 100% 100% 100% Nicotinic acid D 100% 50% 25% Nifedipine D 100% 100% 100% Nimodipine D 100% 100% 100% Nisoldipine Nitrazepam D D 100% 100% 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose as Dose as As normal .Drug Naloxone Naproxen GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD 100% 100% 100% Avoid 100% 100% Avoid 100% 100% Avoid D D CAPD Avoid CRRT Avoid Nalidixic acid D As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Unknown Dose as GFR < 10 No data Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 No data Dose as GFR < 10 IV: 2 mg/kg q48h IP: 7.

Drug GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD GFR < 10 Avoid 100% CAPD GFR < 10 CRRT GFR Nitrofurantoi D n Nitroglycerin D e Nitroprusside D Contraindi Contraindi Contraindi Contraindi Contraindi cated cated cated cated cated 100% 100% No data No data Dose as GFR 10– 50 Dose as GFR 10– 50 Unknown Dose as GFR 10– 50 NA 100% 100% 100% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 NA Dose as GFR < 10 Unknown Dose as GFR < 10 NA Nitrosoureas Nizatidine D D 100% 75% 75% 50% 25–50% 25% Norfloxacin Nortriptyline Ofloxacin I D D q12h 100% 100% q12–24h 100% 50% Avoid 100% 25% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Omeprazole Ondansetron D D 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR 10– 50 NA Dose as GFR 10– 50 Unknown Orphenadrine D Oxaprozin D Oxatomide Oxazepam D D 100% 100% 100% 100% 100% 75% Oxcarbazepin D e Paclitaxel D 100% 100% 100% 100% 100% 100% As normal As normal Dose as GFR GFR GFR 10– .

Drug GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD 100% 50% Avoid Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose after dialysis CAPD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 CRRT 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Pancuronium D Paroxetine D 100% 50–75% 50% Paraamino salicylic acid (PAS) D 100% 50–75% 50% Penbutolol D 100% 100% 100% Dose as GFR < 10 125–250 mg thrice weekly post HD Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Avoid Dose as GFR 10– 50 Avoid Penicillamine D 100% Avoid Avoid Penicillin G D 100% 75% 20–50% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 NA Penicillin VK D 100% 100% 100% Pentamidine I q24h q24–36h q48h Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Unknown Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 100% Pentazocine D 100% 75% 50% Pentobarbital D 100% 100% 100% Unknown Pentopril D 100% 50–75% 50% Dose as GFR < 10 Unknown Pentoxifylline D 100% 100% 100% .

Drug Pefloxacin GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D 100% 100% 100% Dose as GFR < 10 25–50% CAPD Dose as GFR < 10 Unknown CRRT Dose as GFR 10– 50 Dose as GFR 10– 50 Perindopril D 100% 75% 50% Phenelzine D 100% 100% 100% q12–16h As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Dose as GFR 10– 50 Phenobarbital I q8–12h q8–12h Phenylbutazo D ne Phenytoin Pindolol Pioglitazone D D D 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR 100% with As normal As normal As normal caution GFR with GFR with GFR with caution caution caution 25% Dose as GFR < 10 Dose as GFR < 10 Dose post HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Dose as GFR 10– 50 Pipecuronium D 100% 50% Piperacillin I q4–6h q6–8h q8h Piretanide Piroxicam D D 100% 100% 100% 100% 100% 100% Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 Dose as GFR < 10 Unknown NA Dose as GFR 10– 50 Unknown Plicamycin Pravastatin Prazepam D D D 100% 100% 100% 75% 100% 100% 50% 100% 100% As normal As normal As normal GFR GFR GFR Unknown Unknown NA .

Drug Prazosin Prednisolone GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D D 100% 100% 100% 100% 100% 100% CAPD CRRT As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Dose post HD Prednisone D 100% 100% 100% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 No data Pregabalin D 100% 50% q8– q8–12h 12h 25% q24h Dose as GFR < 10 Extra dose post HD Primaquine 100% 100% 100% Dose as GFR < 10 ⅓ dose Avoid Unknown Dose as GFR < 10 Unknown Avoid Unknown Dose as GFR 10– 50 Unknown Avoid Dose as GFR 10– 50 Avoid Primidone Probenecid Probucol I D D q8h 100% 100% q8–12h Avoid 100% q12–24h Avoid 100% Procainamide I Promethazine D Propafenone D q4h 100% 100% q6–12h 100% 100% Avoid 100% 100% Avoid Avoid As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Propofol D 100% 100% 100% 100% 100% 100% 100% Avoid 100% As normal As normal As normal GFR GFR GFR Avoid Dose as GFR < 10 Dose as GFR < 10 Avoid Dose as GFR < 10 Dose as GFR < 10 NA Dose as GFR 10– 50 Dose as GFR 10– 50 Propoxyphen D e Propranolol D Propylthioura D cil 100% 75% 50% .

Drug GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD 100% 100% 50% 100% 100% Dose as GFR < 10 CAPD Dose as GFR < 10 CRRT NA Protryptyline D Pyrazinimide D Pyridostigmin D e Pyrimethamin D e Quazepam Quinapril D D As normal As normal As normal As normal As normal GFR GFR GFR GFR GFR 35% 20% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 100% 100% 100% Unknown 50% As normal As normal As normal GFR GFR GFR Unknown Dose as GFR 10– 50 Dose as GFR < 10 Dose as GFR < 10 Dose post HD Unknown Dose as GFR < 10 NA Dose as GFR 10– 50 Unkno Unknown wn 100% 75–100% Quinidine Quinine D I 100% q8h 100% q8–12h 100% q24h As normal As normal GFR GFR Dose as GFR < 10 Dose as GFR 10– 50 Ramipril D 100% 50–75% 25–50% 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– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Ranitidine D 100% 100% 50% Ribavirin D 100% 100% 50% Rifabutin 100% 100% 100% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 As normal GFR Rifampin Ritonavir D 100% 100% 50–100% 100% 50–100% 100% As normal As normal As normal .

Drug Rituximab GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD GFR 100% CAPD GFR CRRT GFR 100% Use 100% Use 100% Use 100% Use 100% Use with with with with with caution caution caution caution caution 100% 100% 100% 100% 100% 100% 25–50% 100% 100% 100% 100% 10 mg q24h 100% Avoid As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 NA Rosiglitazone D Saquinavir Secobarbital Sertraline Simvastatin Sodium valproate Sotalol D D D D D 100% 100% 100% 100% 100% 100% 100% As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 As normal GFR As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 No data Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Avoid Dose as GFR 10– 50 Sparfloxacin D. I 100% 50–75% 50% q48h Dose as GFR < 10 100% Dose as GFR < 10 Dose as GFR < 10 Spectinomyci D n Spironolacton I e Stavudine D. I 100% 100% Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 q6–12h q12–24h 100% Avoid 50% q12– 50% q24h Dose as 24h GFR < 10 Dose post HD Streptokinase D Streptomycin I 100% q24h 100% q24–72h 100% q72–96h As normal As normal As normal GFR GFR GFR 750 mg 2– 20–40 3/week mg/L/day Unknown Unknown Dose as GFR 10– 50 Unknown Streptozotoci D 100% 75% 50% .

75–1.Drug n GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD 100% 100% 100% Unknown CAPD Unknown CRRT Dose as GFR 10– 50 Dose as GFR 10– 50 750 mg q12h Succinylcholi D ne Sufentanil D 100% 100% 100% Unknown Unknown Sulbactam I q6–8h q12–24h q24–48h Dose as GFR < 10 Dose post HD 0.5 g/day Sulfamethoxa I zole Sulfinpyrazon D e Sulfisoxazole I Sulindac D q12h q18h q24h 1 g after dialysis None 1 g/day Dose as GFR 10– 50 Dose as GFR 10– 50 NA Dose as GFR 10– 50 Unknown 100% 100% Avoid None q6h 100% q8–12h 50–100% q12–24h 50–100% 2 g after dialysis Dose as GFR < 10 Unknown 3 g/day Dose as GFR < 10 Unknown Sulotroban Tacrolimus Tamoxifen Tazobactam D 50% 100% 30% 100% 100% 75% 10% 100% 100% 50% As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR 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 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– D D 100% 100% Teicoplanin I q24h q48–72h q72h Temazepam D 100% 100% 100% Teniposide D 100% 100% 100% .

I 60– 30–70% 90% q12h q8–12h 100% 100% 100% 100% 100% 100% 20–30% q24–48h 100% 100% 100% Tolazamide Tolbutamide Tolmetin D D D Topiramate D 100% 50% 25% .Drug Terazosin Terbutaline GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D D 100% 100% 100% 50% 100% Avoid CAPD CRRT 50 As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Terfenadine Tetracycline D I 100% 100% 100% q24h As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 NA 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 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 q8–12h q12–24h Thiazides Thiopental Ticarcillin D D D. I 100% 100% 1–2 g q4h 100% 100% 100% 1–2 g q8h Avoid 75% 1–2 g q12h 3 g after dialysis 100% 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 Ticlopidine D 100% Tigecycline 100% 100% 100% Timolol D 100% 100% 100% Tobramycin D.

Drug Topotecan Torsemide Tramadol GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD D D D 75% 100% 100% 50% 100% 25% 100% No data Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 CAPD No data Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR < 10 CRRT No data NA Dose as GFR 10– 50 Dose as GFR 10– 50 NA Dose as GFR 10– 50 50–100 mg 50 mg q6–12h q12h 25% 10% Tranexamic acid D 50% Tranylcyprom D ine Trazodone D Unkno Unknown wn 100% 100% Unknown Avoid/50 % 100% Avoid 100% Unknown q12–24h Triamcinolon D e Triamterene Triazolam I D 100% q12h 100% 100% q12h 100% As normal As normal As normal GFR GFR GFR Avoid Dose as GFR < 10 Unknown Unknown Avoid Dose as GFR < 10 Unknown Unknown Avoid NA Unknown Dose as GFR 10– 50 Dose as GFR 10– 50 Trihexypheni D dyl Trimethadion I e Trimethoprim I Unkno Unknown wn q8h q8–12h q12h 50% q18h 50% q24h Dose as GFR < 10 Dose post HD Dose as GFR < 10 Trimetrexate D 100% 100% 50–100% 100% Avoid 100% Unknown Unknown Avoid No data Dose as GFR < 10 Unknown Unknown Unknown No data Dose as GFR < 10 Unknown Unknown Unknown No data NA NA NA Dose as Trimipramine D Tripelennami D ne Triprolidine D Unkno Unknown wn Unkno Unknown wn 75% 50% Tubocurarine D .

I 500 mg 500 mg q6–12h q12–48h 100% 100% 100% 50% Vecuronium Venlafaxine D D As normal As normal As normal GFR GFR GFR Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Infuse post HD Dose as GFR < 10 Dose as GFR < 10 Dose as GFR < 10 Dose as GFR 10– 50 Dose as GFR 10– 50 Dose as GFR 10– 50 Verapamil D 100% 100% 100% Vidarabine D 100% 100% 75% Vigabatrin D 100% 50% 25% Dose as GFR < 10 100% 2– 3/week Dose post HD Dose as GFR < 10 Dose as GFR 10– 50 Vinblastine D 100% 100% 100% As normal As normal GFR GFR Vincristine Vinorelbine Warfarin Zafirlukast Zalcitabine D D D D I 100% 100% 100% 100% 100% 100% 100% 100% 100% q12h 100% 100% 100% 100% q24h As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR As normal As normal As normal GFR GFR GFR Dose as No data Dose as .Drug GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD CAPD CRRT GFR 10– 50 Urokinase D 100% 50– 100% 100% 450 mg q24–48h 100% 450 mg BiW 500 mg q48–96h 100% 50% As normal As normal As normal GFR GFR GFR Avoid Dose as GFR < 10 Avoid Dose as GFR < 10 450 mg q48h Dose as GFR 10– 50 Valganciclovi D r Vancomycin D.

continuous renal replacement therapies. HD. decreasing individual doses. GFR. glomerular filtration rate. . CRRT. NA. not applicable. hemodialysis. I. increasing individual doses. I 100% q8h 100% 100% q8h 50% q12h Dose as GFR < 10 100% 100% Dose as GFR < 10 Dose as GFR < 10 Unknown Dose as GFR 10– 50 Dose as GFR 10– 50 CAPD. chronic ambulatory peritoneal dialysis. D.Drug GFR > Dose 50 GFR 10– Meth (mL/mi 50 GFR < 10 od n) (mL/min) (mL/min) HD GFR < 10 Dose post HD CAPD CRRT GFR 10– 50 Zidovudine (AZT) Zileuton D.

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