Dialysis of Drugs: Curtis A. Johnson, Pharmd

2010
Dialysis of Drugs
Curtis A. Johnson, PharmD

CKD Insights, LLC
Verona, Wisconsin
and
Professor (Emeritus) of Pharmacy and Medicine
University of Wisconsin-Madison
Madison, Wisconsin
2010 Dialysis of Drugs
DISCLAIMERThese Dialysis of Drugs guidelines

are offered as a general summary of information
for pharmacists and other medical professionals.
Inappropriate administration of drugs may involve
serious medical risks to the patient that can only
be identified by medical professionals. Depending
on the circumstances, the risks can be serious and
can include severe injury, including death. These
guidelines cannot identify medical risks specific
to an individual patient or recommend patient
treatment. These guidelines are not to be used as
a substitute for professional training. The absence
of typographical errors is not guaranteed. Use of
these guidelines indicates acknowledgment that
neither CKD Insights, LLC. nor Genzyme will be
responsible for any loss or injury, including death,
sustained in connection with or as a result of the
use of these guidelines. Readers should consult
the complete information available in the package
insert for each agent indicated before prescribing
medications.
Guides such as this one can only draw
from information available as of the date of
publication. Neither CKD Insights, LLC. nor
Genzyme is under any obligation to update
information contained herein. Future medical
advances or product information may affect or
change the information provided. Pharmacists
and other medical professionals using these
guidelines are responsible for monitoring ongoing
medical advances relating to dialysis.
Copyright 2010, CKD Insights, LLC. Printed in
the U.S.A. All rights reserved. This material may
not be published, rewritten or redistributed.
SEE DISCLAIMER REGARDING USE OF THIS GUIDE
I PREFACE
Preface
Drug removal during dialysis is frequently of
interest to those caring for patients receiving
hemodialysis or peritoneal dialysis. The extent
of drug dialyzability determines whether
supplemental dosing is necessary during or
following dialysis. The accompanying table is
a reference regarding the effect of either form
of dialysis on drug clearance. This table should
be used as a general guideline.
The drugs included in the table are parent
drugs. In some cases, these drugs are converted
to pharmacologically active or toxic metabolites
for which little dialysis information is known.
Therefore, for a few drugs, a primary metabolite
is also included in the table. When available,
serum drug measurements may be appropriate
for dosing individual patients. In all cases,
patients should be monitored for clinical
efficacy and toxicity.
What Determines Drug

Dialyzability?
The extent to which a drug is affected by dialysis is
determined primarily by several physicochemical
characteristics of the drug that are briefly described
in the text that follows. These include molecular
size, protein binding, volume of distribution, water
solubility, and plasma clearance. In addition to
these properties of the drug, technical aspects of
the dialysis procedure also may determine the
extent to which a drug is removed by dialysis.
Molecular Weight
Dialysis is dependent upon the use of a dialytic
membrane: either a synthetic membrane
with fixed pore size, as in hemodialysis, or
a naturally occurring peritoneal membrane,
as in peritoneal dialysis. The movement of
drugs or other solutes is largely determined
by the size of these molecules in relation to
the pore size of the membrane. As a general
rule, smaller molecular weight substances will
pass through the membrane more easily than
larger molecular weight substances. A common
assumption is that pore size of the peritoneal
membrane is somewhat larger than that of the
hemodialysis membrane. This would explain
the observation that larger molecular weight
substances appear to cross the peritoneal
membrane to a greater extent than the
hemodialysis membrane.
Protein Binding
Another important factor determining drug
dialyzability is the concentration gradient
of unbound (free) drug across the dialysis
membrane. Drugs with a high degree of protein
binding will have a low plasma concentration
of unbound drug available for dialysis. Uremia
may have an effect on protein binding for some
drugs. Through mechanisms not completely
understood, protein binding may decrease in
uremic serum. Should this change in binding be
substantial, increased dialyzability of free drug
may occur.
I PREFACE
Because the primary binding proteins for most

drugs (albumin, 1-acid glycoprotein) are of
large molecular size, the drug-protein complex
is often unable to cross the dialysis membrane,
especially the hemodialysis membrane. Since the
peritoneal membrane does permit the passage
of some proteins, there may be some limited
drug-protein removal with peritoneal dialysis.
Increased protein concentrations often occur in
peritoneal effluent during episodes of peritonitis.
Volume of Distribution
A drug with a large volume of distribution
is distributed widely throughout tissues and
is present in relatively small amounts in the
blood. Factors that contribute to a large volume
of distribution include a high degree of lipid
solubility and low plasma protein binding.
Drugs with a large volume of distribution are
likely to be dialyzed minimally.
Water Solubility
The dialysate used for either hemodialysis or
peritoneal dialysis is an aqueous solution. In
general, drugs with high water solubility will
be dialyzed to a greater extent than those with
high lipid solubility. Highly lipid-soluble drugs
tend to be distributed throughout tissues, and
therefore only a small fraction of the drug is
present in plasma and accessible for dialysis.
Plasma Clearance
The inherent metabolic clearancethe sum of
renal and nonrenal clearanceis often termed
the plasma clearance of a drug. In dialysis
patients, renal clearance is largely replaced by

dialysis clearance. If nonrenal clearance is large
compared to renal clearance, the contribution of
dialysis to total drug removal is low. However,
if renal (dialysis) clearance increases plasma
clearance by 30% or more, dialysis clearance
is considered to be clinically important.
Dialysis Membrane
As mentioned previously, the characteristics
of the dialysis membrane determine to a
large extent the dialysis of drugs. Pore size,
surface area, and geometry are the primary
determinants of the performance of a given
membrane. The technology of hemodialysis
has evolved, and new membranes have been
introduced for clinical use. Interpretation of
published literature should be tempered with
the understanding that newer hemodialysis
membranes may have different drug dialysis
characteristics. Little can be done to alter the
characteristics of the peritoneal membrane.
Blood and Dialysate Flow Rates

The hemodialysis prescription includes the
desired blood and dialysate flow rates. As drugs
normally move from blood to dialysate, the
flow rates of these two substances may have a
pronounced effect on dialyzability. In general,
increased blood flow rates during hemodialysis
will deliver greater amounts of drug to the
dialysis membrane. As the drug concentration
increases in the dialysate, the flow rate of the
dialysis solution also becomes important in
overall drug removal. Greater dialysis can be
6
I SPECIAL CONSIDERATIONS
achieved with faster dialysate flow rates that keep

the dialysate drug concentration at a minimum.
During peritoneal dialysis, little can be done
to alter blood flow rates to the peritoneum.
However, dialysate flow rates are determined
by the volume and frequency of dialysate
exchange in the peritoneum. At low exchange
rates, drug concentrations in the dialysate
will increase during the time in which the
dialysate resides in the peritoneum, thus
slowing additional movement of drug across
the membrane. More frequent exchanges will
favor increased drug dialyzability, provided the
drugs physicochemical characteristics permit its
movement across the peritoneal membrane.
Special Considerations
HIGH PERMEABILITY DIALYSIS
Much of the information contained in this guide
has been obtained from studies conducted
under conditions of standard hemodialysis that
employed conventional dialysis membranes.
Changes in dialysis technology have led to
more permeable dialysis membranes and
the opportunity to employ higher blood and
dialysate flow rates. These new technologies
are often referred to as high permeability,
high-efficiency, and high-flux dialysis. The
United States Food and Drug Administration has
classified high permeability dialysis membranes
as those whose in vitro ultrafiltration coefficient
(KUf) is greater than 8 mL/hour/mm Hg.
Commonly included in this group of dialysis
membranes are polysulfone, polyacrylonitrile,
and high-efficiency cuprammonium rayon

dialyzers. Changes in dialysis membranes
and changes in blood and dialysis flow rates
may have clinically important effects on drug
removal through the membrane.
There are an increasing number of studies that
examine the effects of high permeability dialysis
on drug dialyzability. Results of these studies
confirm predictions that drug removal from
plasma is often enhanced as compared with
more traditional dialysis membranes. Studies
with high permeability dialysis also demonstrate
that removal of drug from plasma often exceeds
the transfer of drug from tissues to plasma. As a
result, a rebound of plasma drug concentrations
following the conclusion of dialysis may occur
as blood-tissue drug equilibration occurs.
Patients receiving high permeability dialysis
may require more drug compared with those
receiving standard hemodialysis. Due to the
many technical and physiological variables,
individualized therapeutic drug monitoring
may be necessary. The reader is referred to the
primary literature for further details.
CONTINUOUS RENAL
REPLACEMENT THERAPY
Another therapeutic development that will
affect drug dialyzability is continuous renal
replacement therapy (CRRT), known in its
various forms as continuous arteriovenous
hemofiltration (CAVH), continuous venovenous
hemofiltration (CVVH), continuous
arteriovenous hemodialysis (CAVHD),
continuous venovenous hemodialysis (CVVHD),
8
continuous venovenous hemodiafiltration

(CVVHDF), continuous arteriovenous
hemodiafiltration (CAVHDF), slow continuous
ultrafiltration (SCUF), continuous arteriovenous
high-flux hemodialysis (CAVHFD), and
continuous venovenous high-flux hemodialysis
(CVVHFD). These various techniques are used
in the management of acute renal failure in
critically ill patients.
Continuous renal replacement therapies differ
considerably from intermittent hemodialysis.
Relying heavily upon continuous ultrafiltration
of plasma water, CRRT has the potential for
the removal of large quantities of ultrafilterable
drugs contained in plasma. Unfortunately,
few in vivo studies have been published,
and very few drugs have been studied
pharmacokinetically in intensive care patients.
Therefore, many guidelines for drug dosing
during CRRT are extrapolated from experiences
with chronic hemodialysis or from theoretical
considerations based upon general principles of
drug removal derived from the physicochemical
characteristics of the drug and the CRRT
technique employed.
Molecular weight of a drug has been an
important determinant of drug dialyzability
in conventional hemodialysis. This drug
characteristic becomes less important
during CRRT because of the use of highflux hemofilters that permit passage of larger
molecules up to 5000 Da. As is true with
conventional hemodialysis, drugs with a
large volume of distribution are unlikely to be
removed to a great extent during CRRT. Most
of the body stores of such drugs are outside the

vascular compartment and not accessible to the
hemofilter for removal. Similarly, drugs that are
highly bound to plasma proteins are not subject
to significant removal during CRRT because the
molecular weight of drug-protein complexes
usually hinders passage of the complex across
the filter. The fraction of unbound drug may
change during renal failure, however, thus
altering the likelihood of drug removal. If
the unbound fraction increases, more drug
clearance may occur. If the unbound fraction
becomes less, there is likely to be less drug
removal during CRRT.
A useful tool to predict the likelihood of a drug
to cross the hemofilter membrane is the sieving
coefficient. This term is defined as the ratio of
drug concentration in the ultrafiltrate to the
prefilter plasma water concentration of the drug.
If the sieving coefficient is close to 1.0, the drug
has relatively free passage across the filter. The
following table presents sieving coefficient data
from in vitro and in vivo evaluations.
SIEVING COEFFICIENT
Drug Name
Amikacin
Amphotericin
Ampicillin
Cefotaxime
Cefoxitin
Ceftazidime
Ceftriaxone
10
Predicted Measured Condition Filter

0.95
0.88
in vivo
PSa
0.10
0.40
in vivo
PSa
0.80
0.69
in vivo
PSa
0.62
0.51
in vivo
PSa
0.30
0.30
in vitro
PSa
0.90
0.90
in vivo
PSa
0.10
0.71
in vivo
PSa

0.66
0.59
in vivo
PSa
Clindamycin
0.40
0.98
in vivo
PSa
Digoxin
0.80
0.96
in vivo
PSa
0.35
in vitro
PSa
0.18
in vitro
PSb
1.21
in vitro
AN69c
1.07
in vitro
PAd
Erythromycin
0.30
0.37
in vivo
PSa
Gentamicin
0.95
0.81
in vivo
PSa
Metronidazole
0.80
0.86
in vivo
PSa
Mezlocillin
N-acetylprocainamide
Nafcillin
0.68
0.68
in vivo
PSa
0.90
0.92
in vivo
PSa
0.20
0.54
in vivo
PSa
Oxacillin
0.05
0.02
in vivo
PSa
Phenobarbital
0.60
0.86
in vivo
PSa
Phenytoin
0.10
0.45
in vivo
PSa
0.14
in vitro
PSa
0.12
in vitro
PSb
0.08
in vitro
AN69c
0.17
in vitro
PAd
0.08
in vitro
PSa
Procainamide
0.86
0.86
in vivo
PSa
Theophylline
0.47
0.85
in vitro
PSa
0.93
in vitro
AN69c
0.78
in vivo
PAd
0.78
in vivo
PSa
0.90
in vitro
PSa
Tobramycin
Drug Name
Cefuroxime
0.95
11
Drug Name
Tobramycin
Valproic acid
Vancomycin

0.95
0.75
in vitro
PSb
0.59
in vitro AN69c
0.76
in vitro
PAd
0.10
0.18
in vitro
PSa
0.31
in vitro AN69c
0.16
in vitro
PAd
0.90
0.76
in vivo
PSa
0.60
in vitro
PSa
0.71
in vitro
PSb
0.64
in vitro AN69c
0.58
in vitro
PAd
Amicon dialter (polysulfone)

Renal System (polysulfone)
c
Hospal (AN69)
d
Gambro (polyamide)
The above table was published in the following
article: Joy MS, Matzke, GR, Armstrong DK, Marx MA,
Zarowitz BJ. A primer on continuous renal replacement
therapy for critically ill patients. Ann Pharmacother.
1998;32:362-75. Reprinted with permission. Harvey
Whitney Books Company.
b
The specific CRRT technique employed will

influence the ultrafiltration rate and hence, the
potential rate of drug removal. When CRRT
relies solely on spontaneous blood flow without
extracorporeal blood pumping, an ultrafiltration
rate of 10-15 mL/min is anticipated. The
addition of blood pumps and continuous
dialysis may increase the ultrafiltration rate to 50
mL/min. Higher rates of ultrafiltration may lead
to greater drug removal with a need for more
12
frequent replacement doses. Drug removal can

be determined by collection of the total volume
of dialysate/ultrafiltrate and measurement of the
concentration of drug in the effluent.
Because of the multiple techniques employed
in CRRT, the variability in individual patient
circumstances, and the lack of in vivo data, the
tables in this guide do not contain information
on drug removal during CRRT. Once again, the
reader is referred to the primary literature for
assistance with the dosing of specific drugs.
PLASMAPHERESIS
Plasmapheresis is another special consideration
in which drug removal from plasma may be of
concern. This technique is used for the treatment
of certain immunologic, infectious, and
metabolic diseases, as well as for the removal of
toxins that cannot be removed by hemodialysis
or peritoneal dialysis. Plasmapheresis removes
plasma from the patient with replacement
by crystalloid or colloid solutions. Solutes
such as drug molecules that are present in
the plasma may be removed from the patient.
Unfortunately, little is known about the specific
pharmacokinetic effects of plasmapheresis.
The procedure may be most likely to remove
substances that are lipophilic, that are highly
protein-bound, and that have a small volume of
distribution. The reader is referred to reference 5.
SUMMARY
Drug dialyzability is determined by a complex
interaction of many factors, including the
characteristics of the drug and the technical
13
aspects of the dialysis system. Published

studies on drug dialyzability should specify the
conditions that pertain during dialysis. Results
from these studies should be applied with
caution to other dialysis conditions.
About This Guide

These guidelines are designed to provide
extensive, easy-to-read information regarding
the dialyzability of drugs. Numerous literature
sources have been used in preparing the
guidelines. For many drugs, including newlyapproved medications, no studies have been
done to determine the effect of dialysis on drug
removal. In some cases, the available data may
conflict. Conditions of dialysis used in published
studies may not necessarily reflect current
dialysis procedures and technology. Variations
in the duration of dialysis, flow rates, dialysis
membranes, and whether peritoneal dialysis is
continuous or intermittent will all affect drug
removal. This educational review will distinguish
between conventional hemodialysis and high
permeability (often called high-flux) hemodialysis
where such data are available. However,
the review does not contain information on
drug dialyzability with CRRT (See Special
Considerations, page 8) or with plasmapheresis.
For additional information on specific drugs, the
reader should consult the primary literature.
A designation of Yes in the Hemodialysis
and Peritoneal Dialysis columns indicates that
dialysis enhances plasma clearance by 30% or
more. Supplemental dosing may be required
or dosing after dialysis should be considered.
14
I ABOUT THIS GUIDE
No indicates that dialysis does not have a

clinically important effect on plasma clearance.
Supplemental dosing is usually not required. As
a general principle, usual methods of continuous
ambulatory peritoneal dialysis (CAPD) provide
relatively low drug clearances during any given
dialysate exchange. However, cumulative drug
removal may require dosage supplementation
at appropriate intervals. Relatively little research
has examined peritoneal drug clearance in
PD techniques that utilize automated systems
employing large volumes of short dwells at
night, often accompanied by one or more longer
daytime dwells (APD). Similarly, little data exists
on the effects of tidal peritoneal dialysis on drug
clearance. A few studies have confirmed that
clearance of some drugs is increased by APD
due to the increased drug concentration gradient
between blood and dialysate. Increased drug
dialyzability may occur with increased peritoneal
dialysate flow rates or in the presence of
peritonitis. A designation of U indicates that no
dialysis studies have been published, but that the
author of this guide has concluded that significant
drug removal during dialysis is unlikely based
upon the physicochemical characteristics of
the drug, which are primarily a high degree of
protein binding, a large molecular weight, or a
large volume of distribution. A designation of
L indicates that no published data exist on the
removal of the drug during high permeability
dialysis. However, the author has extrapolated
data from studies using conventional dialysis to
conclude that significant drug removal is likely
to occur during high permeability dialysis. A
designation of ND indicates that no data are
15
available on drug dialyzability. In some cases, the

literature reports the use of a high permeability, or
high-flux, dialysis membrane, however the type
of membrane is not specified. A designation of
NS indicates membrane type is not specified.
Key
Yes Indicates that dialysis enhances plasma clearance by
30% or more. Supplemental dosing may be required
or dosing after dialysis should be considered.
No Indicates that dialysis does not have a
clinically important effect on plasma clearance.
Supplemental dosing is usually not required.
U Indicates signicant drug removal is unlikely based
on physicochemical characteristics of the drug
such as protein binding, molecular size or volume
of distribution
L Indicates no published data exist, but information
extrapolated from studies using conventional
dialysis techniques suggests signicant drug
removal is likely during high permeability dialysis
ND Indicates there are no data on drug dialyzability
with this type of dialysis
NS Indicates the type of membrane was not specied
* Removed with hemoperfusion
Note: In these tables, conventional hemodialysis is
dened as the use of a dialysis membrane whose in
vitro coefcient of ultraltration (KUf) 8 mL/hour/mm
Hg. Data also are placed in the conventional column
if the literature does not specify the type of dialysis
membrane employed. High permeability hemodialysis
is dened as the use of a dialysis membrane whose
KUf >8 mL/hour/mm Hg. In the tables, the KUf of the
membrane(s) used is included in parentheses.
16
Abacavir
Abatacept
Abciximab
Acamprosate
Acarbose
Acebutolol (diacetolol)
Acetaminophen
Acetazolamide
Acetohexamide
Acetophenazine
Acetylcysteine
Acitretin
Acrivastine
Acyclovir
Adalimumab
Adefovir
Adenosine
Agalsidase alfa
Agalsidase beta
Albendazole
Albumin
Albuterol
Aldesleukin
Alefacept
Alemtuzumab
Alendronate
Alfentanil
Alfuzosin
Alglucerase
Aliskiren
I CHART
Drug
HEMODIALYSIS
Conventional High Permeability Peritoneal
(KUf)
(KUf)
Dialysis
U
U
U
ND
ND
Yes (NS)
Yes (NS)
U
U
U
Yes (7.5)
No (NS)
ND
Yes (NS)
U
Yes (NS)
U
No (7.5)
U
No (NS)
U
No (NS)
ND
ND
U
No (NS)
U
U
U
ND
No (40)
U
ND
ND
ND
L
L
ND
ND
ND
ND
U
ND
L
U
ND
ND
No (10)
U
ND
ND
ND
ND
ND
U
ND
ND
U
U
ND
ND
U
U
ND
ND
ND
No
No
U
U
ND
U
ND
No
U
ND
U
U
U
U
U
U
ND
ND
U
ND
U
U
U
ND
17
Drug
Allopurinol
Almotriptan
Alosetron
Alprazolam
Alprostadil
Alteplase
Altretamine
Alvimopan
Amantadine
Ambenonium
Ambrisentan
Amdinocillin
Amifostine
Amikacin
Amiloride
Aminocaproic acid
Aminoglutethimide
Aminosalicylic acid
Amiodarone
Amitriptyline
Amlodipine
Amoxapine
Amoxicillin
Amphetamine
Amphotericin B
Amphotericin B lipid
complex
Ampicillin
Amprenavir
Amrinone
18
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Yes (NS)
ND
ND
No (NS)
U
U
ND
ND
No (NS)
ND
U
No (NS)
ND
Yes (NS)
ND
Yes (NS)
Yes (NS)
Yes (NS)
No (NS)
No (NS)
No (NS)
U
Yes (NS)
ND
No (NS)
L
ND
ND
ND
No (11.1)
ND
ND
ND
ND
ND
U
ND
ND
L
ND
ND
L
L
U
ND
U
U
L
ND
No (10.1, 36)
ND
ND
ND
U
ND
U
ND
ND
No
ND
U
No
ND
Yes
ND
Yes
ND
ND
No
No
No
U
No
ND
No
No (NS)
ND
Yes (NS)
U
U
L
ND
ND
No
U
No
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Amsacrine
U
Anagrelide
ND
Anakinra
No (NS)
Anastrozole
ND
Anidulafungin
No (NS)
Anisindione
U
Anisoylated
plasminogen
ND
streptokinase activator
complex
Anistreplase
U
Antithymocyte globulin
U
(ATG)
Apomorphine
U
Aprepitant
No (NS)
Aprotinin
U
Arbutamine
ND
Argatroban
U
Aripiprazole
U
Armodanil
ND
Arsenic trioxide
No (NS)
Artemether/
ND
lumefantrine
Articaine
ND
Ascorbic acid
Yes (5.5)
Asparaginase
U
Aspirin
Yes (NS)
Atazanavir
U
Atenolol
Yes (NS)
Atomoxetine
U
Atorvastatin
No (NS)
U
ND
ND
ND
U
U
U
ND
No
ND
U
U
ND
ND
ND
ND
U
U
ND
ND
No (10.7-36)
U
ND
ND
U
U
U
ND
ND
U
ND
U
ND
ND
ND
Yes (8.8)
ND
L
U
L
U
U
ND
Yes
U
Yes
U
No
U
U
19
Drug
Atovaquone
Atracurium
Atropine
Auranon
Azacitidine
Azathioprine
Azelastine
Azithromycin
Azlocillin
Aztreonam
Baclofen
Balsalazide
Basiliximab
Benazepril
(benazeprilat)
Bendamustine
Bendroumethiazide
Benzphetamine
Benzquinamide
Benztropine
Bepridil
Beractant
Besioxacin
Betamethasone
Betaxolol
Bethanechol
Bevacizumab
Bexarotene
Bezabrate
Biapenem
20
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
U
U
No (NS)
No (NS)
ND
Yes (NS)
U
ND
Yes (NS)
Yes (NS)
ND
U
U
ND
ND
ND
ND
ND
L
U
ND
L
L
Yes (60)
U
ND
U
U
ND
ND
ND
ND
U
No
No
No
ND
U
U
No (NS)
ND
ND
U
No (NS)
ND
U
ND
No (NS)
U
ND
ND
No (NS)
ND
U
U
No (NS)
Yes (NS)
U
ND
ND
ND
ND
ND
U
ND
ND
ND
ND
No (NS)
U
U
Yes (NS)
U
U
ND
ND
ND
U
U
ND
ND
No
ND
U
U
No
ND
Bicalutamide
Biperiden
Bisoprolol
Bivalirudin
Bleomycin
Bortezomib
Bosentan
Bretylium
Bromfenac
Bromocriptine
Brompheniramine
Budesonide
Buomedil
Bumetanide
Bupivacaine
Buprenorphine
Bupropion
Buspirone
Busulfan
Butalbital
Butoconazole
Butorphanol
Cabergoline
Caffeine
Calcitonin
Calcitriol
Calfactant
Canakinumab
Candesartan
Capecitabine
U
ND
No (NS)
Yes (NS)
No (NS)
ND
U
Yes (NS)
No (NS)
U
ND
U
No (NS)
U
U
U
No (NS)
No (NS)
Yes (NS)
ND
U
U
ND
ND
U
No (4.2-5.3)
ND
U
No (NS)
ND
ND
ND
ND
ND
ND
ND
No (11.1)
L
U
ND
ND
U
No (20)
U
U
U
No (10)
ND
Yes (8.1)
ND
U
ND
ND
ND
U
No (31)
ND
U
No (8.1)
ND
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
U
ND
ND
ND
No
ND
U
ND
U
U
ND
U
U
U
U
U
No
ND
ND
ND
U
U
ND
ND
U
U
ND
U
ND
ND
21
Drug
Capreomycin
Captopril
Carbamazepine
Carbenicillin
Carbidopa/levodopa
Carbinoxamine
Carboplatin
Carboprost
Carisoprodol
Carmustine
Carprofen
Carteolol
Carumonam
Carvedilol
Caspofungin
Cefaclor
Cefadroxil
Cefamandole
Cefazolin
Cefdinir
Cefditoren
Cefepime
Cexime
Cefmenoxime
Cefmetazole
Cefodizime
Cefonicid
Cefoperazone
Ceforanide
Cefotaxime
22
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Yes (NS)
Yes (NS)
No (NS)
Yes (NS)
ND/U
ND
Yes (NS)
ND
Yes (NS)
No (NS)
U
ND
Yes (NS)
No (NS)
No (NS)
Yes (NS)
Yes (NS)
Yes (NS)
Yes (6, 8)
ND
No (NS)
Yes (NS)
No (NS)
Yes (NS)
Yes (NS)
No (NS)
No (NS)
No (NS)
Yes (NS)
Yes (NS)
L
L
Yes (22, 55)
L
ND/U
ND
L
ND
L
ND
U
ND
L
U
U
L
L
L
Yes (8.1-60)
Yes (NS)
ND
Yes (40, 60)
ND
L
L
ND
ND
ND
L
L
ND
No
No
No
ND/U
ND
No
ND
Yes
ND
U
ND
ND
U
U
Yes
No
No
No
ND
ND
Yes
No
ND
No
No
No
No
No
No
Cefoxitin
Cefpirome
Cefpodoxime
Cefprozil
Cefroxadine
Cefsulodin
Ceftazidime
Ceftibuten
Ceftizoxime
Ceftobiprole
Ceftriaxone
Cefuroxime
Celecoxib
Cephalexin
Cephalothin
Cephapirin
Cephradine
Certolizumab
Cetirizine
Cetrorelix
Cetuximab
Cevimeline
Chloral hydrate
Chlorambucil
Chloramphenicol
Chlordiazepoxide
Chloroquine
Chlorothiazide
Chlorpheniramine
Chlorpromazine
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Yes (NS)
Yes (NS)
Yes (NS)
Yes (NS)
ND
Yes (NS)
Yes (NS)
Yes (NS)
Yes (NS)
ND
No (NS)
Yes (NS)
U
Yes (NS)
Yes (NS)
Yes (NS)
Yes (NS)
U
U
ND
No (NS)
ND
Yes (5.5)
No (NS)
Yes (NS)
No (NS)
No (NS)
No (NS)
Yes (NS)
No (NS)
L
Yes (40)
L
L
ND
L
L
L
L
ND
ND
L
U
L
L
L
L
U
No (18.7-66.7)
ND
U
ND
L
ND
L
U
ND
ND
L
U
No
No
No
ND
ND
Yes
Yes
ND
No
ND
No
No
U
No
No
No
Yes
U
U
ND
U
ND
ND
No
No
U
No
U
No
No
23
Drug
Chlorpropamide
Chlorprothixene
Chlorthalidone
Chlorzoxazone
Cholecalciferol
Cholestyramine
Choriogonadotropin
Ciclesonide
Cidofovir
Cilastatin
Cilazapril
Cilostazol
Cimetidine
Cinacalcet
Cinoxacin
Ciprooxacin
Cisapride
Cisatracurium
Cisplatin
Citalopram
Cladribine
Clarithromycin
Clavulanic acid
Clemastine
Clevidipine
Clinaoxacin
Clindamycin
Clodronate
Clofarabine
Clofazimine
24
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
No* (NS)
U
No (NS)
ND
U
U
U
U
ND
Yes (NS)
Yes (NS)
U
No (NS)
No (NS)
No (NS)
No (NS)
No (NS)
U
No (NS)
No (8)
ND
ND
Yes (NS)
U
U
No (6.4)
No (NS)
ND
ND
No (NS)
ND
ND
ND
ND
U
U
U
U
Yes (60)
L
L
U
ND
U
ND
ND
U
ND
Yes (NS)
No (40)
ND
ND
L
U
U
No (8.1, 8.8)
ND
Yes (8.1)
ND
ND
No
U
U
ND
U
U
U
U
No
ND
ND
U
No
No
U
No
U
U
ND
U
ND
ND
Yes
U
U
ND
No
No
ND
No
Clobrate
Clomiphene
Clomipramine
Clonazepam
Clonidine
Clopidogrel
Clorazepate
Clotrimazole
Cloxacillin
Clozapine
Codeine
Colchicine
Colesevalam
Colestipol
Colistin
Conivaptan
Cortisone
Cromolyn sodium
Cyanocobalamin
Cyclacillin
Cyclobenzaprine
Cyclophosphamide
Cycloserine
Cyclosporine
Cyproheptadine
Cystadane
Cysteamine
Cytarabine
Dabigatran
Dacarbazine
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
No (NS)
ND
U
No (NS)
No (NS)
U
No (NS)
U
No (NS)
U
No (NS)
No (NS)
U
U
No (NS)
U
No (NS)
U
No (NS)
Yes (NS)
U
Yes (6.4)
ND
No (NS)
ND
ND
ND
ND
ND
ND
U
ND
U
ND
ND
ND
ND
U
ND
U
ND
ND
U
U
ND
U
ND
U
No (40, 65)
L
U
L
Yes (30, 52)
U
ND
ND
ND
Yes (NS)
ND
ND
No
ND
U
U
No
U
U
U
No
U
U
No
U
U
No
U
No
U
ND
No
U
ND
ND
No
ND
ND
No
No
ND
ND
25
Drug
Daclizumab
Dactinomycin
Dalbavancin
Dalteparin
Danaparoid
Dantrolene
Dapsone
Daptomycin
Darbepoetin alfa
Darifenacin
Darunavir
Dasatinib
Daunorubicin
Decitabine
Deferasirox
Deferoxamine
Deazacort
Degarelix
Delavirdine
Demeclocycline
Denileukin
Desipramine
Desloratadine
Desmopressin
Desogestrel
Desvenlafaxine
Dexamethasone
Dexchlorpheniramine
Dexfenuramine
Dexmedetomidine
26
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
U
ND
No (NS)
U
ND
ND
Yes (NS)
No (NS)
U
U
U
U
ND
ND
U
Yes (NS)
No (NS)
U
U
ND
U
No (NS)
No (NS)
ND
U
No (NS)
No (NS)
Yes (NS)
ND
U
ND
ND
ND
ND
ND
ND
L
U
No (11.1-55)
U
U
U
ND
ND
U
L
ND
U
ND
ND
U
ND
ND
ND
U
U
ND
L
ND
U
U
ND
U
U
ND
ND
ND
No
U
U
U
U
ND
ND
U
ND
U
U
U
ND
U
No
No
ND
U
U
No
No
ND
U
Dexmethylphenidate
Dexrazoxane
Dextroamphetamine
Dezocine
Diatrizoate
Diazepam
Diazoxide
Dibekacin
Diclofenac
Dicloxacillin
Dicyclomine
Didanosine
Diethylpropion
Diethylstilbesterol
(fosfestrol)
Diunisal
Digitoxin
Digoxin
Digoxin immune Fab
Dihydrocodeine
Dihydroergotamine
Diltiazem
Dimenhydrinate
Dimyristoyl lecithin
Dinoprostone
Diphenhydramine
Diphenoxylate/
Atropine
Dipyridamole
Dirithromycin
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
ND
ND
ND
L
No (NS)
Yes (NS)
Yes (NS)
U
No (NS)
ND
No (7.9)
ND
ND
ND
ND
ND
Yes (NS)
ND
L
L
ND
ND
ND
No (40)
ND
ND
ND
ND
ND
ND
U
Yes
ND
U
No
ND
No
ND
No (NS)
ND
ND
No (NS)
No (NS)
No (NS)
No (NS)
ND
ND
No (NS)
ND
ND
ND
U
ND
ND
ND
U
ND
ND
ND
ND
ND
ND
ND
U
No
No
No
ND
ND
No
ND
ND
ND
U
ND
ND
ND
U
No (NS)
ND
ND
ND
No
27
Drug
Disopyramide
Disulram
Divalproex
Dobutamine
Docetaxel
Dofetilide
Dolasetron
Domperidone
Donepezil
Dopamine
Doripenem
Dornase alfa
Doxacurium
Doxapram
Doxazosin
Doxepin
Doxercalciferol
Doxorubicin
Doxycycline
Doxylamine
Dronabinol
Dronedarone
Droperidol
Drosperinone
Drotrecogin alfa
Duloxetine
Dutasteride
Eculizumab
Edetate calcium
(ETDA)
28
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
No (NS)
U
No (NS)
No (NS)
No (NS)
ND
ND
U
U
No (NS)
Yes (NS)
U
No (NS)
ND
No (NS)
No (NS)
No (NS)
No (NS)
No (NS)
ND
U
U
U
U
U
U
U
U
U
U
ND
ND
U
ND
ND
U
ND
ND
ND
U
ND
ND
ND
ND
U
ND
ND
ND
ND
U
ND
U
U
U
U
U
U
U
No
No
U
ND
ND
U
U
U
ND
U
U
ND
No
No
U
ND
No
ND
U
U
U
U
U
U
U
U
Yes (NS)
Yes
Edrophonium
Efalizumab
Efavirenz
Eletriptan
Eltrombopag
Emtricitabine
Enalapril (enalaprilat)
Encainide
Enfuvirtide
Enoxacin
Enoxaparin
Entacapone
Entecavir
Enfuvirtide
Ephedrine
Epinephrine
Epirubicin
Eplerenone
Epoetin alfa
Epoprostenol
Eprosartan
Eptacog alfa
Eptibatide
Ergocalciferol
Ergotamine
Erlotinib
Ertapenem
Erythromycin
Escitalopram
Eslicarbazine
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
U
No (NS)
ND
ND
Yes (NS)
Yes (NS)
No (NS)
No (NS)
No (NS)
No (NS)
U
No (NS)
No (NS)
ND
ND
ND
No (7)
No (NS)
ND
U
U
ND
ND
ND
U
Yes (NS)
No (NS)
ND
Yes (NS)
ND
U
ND
ND
ND
ND
L
ND
U
ND
Yes (11.5-55)
U
ND
U
ND
ND
ND
ND
No (11.1-55)
ND
No (60)
U
ND
ND
ND
U
L
ND
ND
L
ND
U
No
ND
ND
ND
Yes
ND
U
No
No
U
No
U
ND
ND
ND
ND
No
ND
U
U
ND
ND
ND
U
ND
No
ND
ND
29
Drug
Esmolol (ASL-8123)
Esomeprazole
Estazolam
Estradiol
Estramustine
Estrogens, conjugated
Estrone
Estropipate
Eszopiclone
Etanercept
Ethacrynic acid
Ethambutol
Ethanolamine oleate
Ethchlorvynol
Ethinyl estradiol
Ethionamide
Ethosuximide
Ethotoin
Etidronate
Etodolac
Etonogestrel
Etoposide
Etoricoxib
Etravirine
Everolimus
Exemestane
Exenatide
Ezetimibe
Famciclovir
(penciclovir)
30
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Yes (NS)
U
U
No (NS)
ND
ND
No (NS)
U
ND
No (NS)
No (NS)
No (NS)
ND
No* (NS)
U
U
Yes (NS)
ND
ND
No (NS)
ND
No (NS)
No (NS)
U
ND
U
ND
U
L
U
U
U
ND
ND
ND
U
ND
U
U
No (80)
ND
ND
U
No (30, 52)
L
ND
ND
U
ND
No (NS)
U
U
ND
U
ND
U
Yes
U
U
U
ND
ND
ND
U
ND
U
U
U
ND
No
No
U
ND
ND
ND
U
ND
No
U
U
ND
U
ND
U
Yes (NS)
ND
Famotidine
Febuxostat
Felbamate
Felodipine
Fenuramine
Fenobrate
Fenoldopam
Fenoprofen
Fentanyl
Ferric gluconate
Ferrous (iron) salts
Ferumoxytol
Fesoterodine
Fexofenadine
Filgrastim
Finasteride
Flavoxate
Flecainide
Fleroxacin
Floxuridine
Fluconazole
Flucytosine
Fludarabine
Fludrocortisone
Flumazenil
Fluorouracil/FBAL
Fluoxetine
Fluoxymesterone
Fluphenazine
Flurazepam
No (NS)
ND
U
U
ND
ND
No (NS)
U
ND
ND
No (NS)
U
U
ND
No (NS)
U
U
No (10.1)
No (NS)
ND
U
ND
No (NS)
ND
ND
ND
No (NS)
ND
No (NS)
ND
U
ND
ND
ND
No (NS)
ND
U
No (8.1, 22)
ND
ND
Yes (NS)
L
Yes (NS)
L
ND
ND
ND
ND
ND
ND
No (NS)/ND No (40)/Yes (40)
No (NS)
U
ND
ND
U
ND
No (NS)
ND
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
No
U
ND
U
ND
U
No
U
ND
U
U
ND
ND
U
U
U
ND
U
No
ND
Yes
Yes
ND
ND
ND
ND
No
ND
U
U
31
Drug
Flurbiprofen
Flutamide
Fluticasone
Fluvastatin
Fluvoxamine
Folic acid
Follitropin alfa
Follitropin beta
Fomepizole
Fondaparinux
Fosamprenavir
Fosaprepitant
Foscarnet
Fosfomycin
Fosinopril (fosinoprilat)
Fosphenytoin
Frovatriptan
Fulvestrant
Furosemide
Fusidic acid
Gabapentin
Gadobenate
Gadobutrol
Gadodiamide
Gadolinium
Gadopentetate
Gadoteridol
Gadoversetamide
Gadoxetate
Galantamine
32
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
U
No (NS)
U
No (NS)
U
Yes (NS)
ND
ND
Yes (NS)
No (NS)
U
No (NS)
Yes (4.1)
Yes (NS)
No (NS)
U
ND
U
No (NS)
No (NS)
Yes (NS)
ND
Yes (5.5)
Yes (NS)
Yes (NS)
Yes (NS)
ND
ND
Yes (NS)
ND
U
ND
U
U
No (NS)
L
ND
ND
L
ND
U
U
Yes (18-60)
L
ND
U
ND
U
U
ND
L
ND
L
L
ND
L
ND
Yes (NS)
L
ND
No
U
U
U
U
ND
ND
ND
ND
U
U
U
ND
ND
No
U
ND
U
U
No
ND
ND
ND
No
ND
ND
ND
ND
ND
ND
Gallium
Gallopamil
Galsulfase
Ganciclovir
Ganirelix
Garenoxacin
Gatioxacin
Geftinib
Gemcitabine
Gembrozil
Gemioxacin
Gemtuzumab
Gentamicin
Gestodene
Glatiramer
Gliclazide
Glimepiride
Glipizide
Glucagon
Glutethimide
Glyburide
Glycopyrrolate
Gold sodium
thiomalate
Golimumab
Goserelin
Granisetron
Grepaoxacin
Griseofulvin
Guaifenesin
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
U
U
Yes (NS)
ND
No (NS)
ND
U
Yes (7)
No (NS)
No (NS)
U
Yes (NS)
U
ND
U
U
U
U
No* (NS)
No (NS)
ND
ND
U
U
L
ND
ND
ND
No (20)
Yes (53, 58)
U
ND
U
Yes (13.2-60)
U
ND
U
U
U
ND
ND
U
ND
ND
U
U
ND
ND
No
ND
U
ND
No
ND
U
Yes
U
ND
U
U
U
U
No
U
ND
No (NS)
ND
U
ND
ND
ND
ND
ND
U
ND
ND
ND
ND
ND
U
ND
ND
ND
ND
ND
33
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Guanabenz
U
Guanadrel
ND
Guanethidine
ND
Guanfacine
No (NS)
Guanidine
ND
Halofantrine
ND
Haloperidol
No (NS)
Heparin
No (NS)
Hexobarbital
No (NS)
Hirudin
No (4.3-6.5)
Hydralazine
No (NS)
Hydrochlorothiazide
No (NS)
Hydrocodone
ND
Hydrocortisone
U
Hydromorphone
No (NS)
Hydroxychloroquine
ND
Hydroxyurea
No (NS)
Hydroxyzine
No (NS)
Ibandronate
ND
Ibritumomab
U
Ibuprofen
No (NS)
Ibutilide
ND
Idarubicin
U
Idebenone
U
Idursulfase
U
Ifosfamide
Yes (1.6)
Iloperidone
U
Iloprost
ND
Imatinib
No (NS)
Imidapril (imidaprilat)
No (NS)
34
U
ND
ND
ND
ND
ND
U
ND
ND
Yes (20-90)
ND
ND
ND
ND
ND
ND
ND
U
Yes (8.1)
U
U
ND
U
U
U
L
U
ND
U
U
U
ND
ND
No
ND
ND
No
No
U
ND
No
U
ND
U
U
ND
U
No
ND
U
U
ND
U
U
U
ND
U
ND
U
U
Imiglucerase
Imipenem
Imipramine
Immune globulin
Indapamide
Indinavir
Indomethacin
Iniximab
Insulin
Insulin aspart
Insulin detemir
Insulin glargine
Insulin glulisine
Insulin lispro
Interferons
Iobenguane
Iodipamide
Iodixanol
Iohexol
Iomeprol
Iopamidol
Iopromide
Iotrolan
Ioversol
Ioxaglic acid
Ioxilan
Ioxitalamic acid
Irbesartan
Irinotecan
(SN-38 metabolite)
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
U
Yes (NS)
No (NS)
U
No (NS)
U
No (NS)
U
No (NS)
U
No (NS)
U
U
U
No (NS)
No (NS)
ND
Yes (3.1, 4.2)
Yes (NS)
Yes (6.8)
Yes (4.8)
Yes (5.5-6.8)
Yes (NS)
Yes (6.3)
L
Yes (NS)
ND
No (NS)
U/U
U
L
U
ND
ND
No (40)
U
U
ND
ND
U
ND
ND
ND
Yes (20-33)
ND
ND
L
Yes (15.5)
L
L
Yes (8.1-62)
L
L
Yes (15.5)
L
ND
ND
No (8.5)/
No (8.5)
U
Yes
No
U
U
ND
U
U
No
U
ND
U
ND
U
No
ND
ND
ND
ND
Yes
Yes
ND
ND
ND
ND
ND
ND
ND
U/U
35
Drug
Iron dextran
Iron sucrose
Isocarboxazid
Isoniazid
Isoproterenol
Isosorbide dinitrate
Isosorbide mononitrate
Isotretinoin
Isradipine
Itraconazole
Ivermectin
Ixabepilone
Kanamycin
Ketamine
Ketoconazole
Ketoprofen
Ketorolac
Ketotifen
Labetolol
Lacosamide
Lactulose
Lamivudine
Lamotrigine
Lanreotide
Lansoprazole
Lanthanum carbonate
Lapatinib
Laronidase
Leunomide
Lenalidomide
36
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
U
U
ND
No (NS)
ND
No (NS)
Yes (NS)
U
No (NS)
No (NS)
ND
ND
Yes (NS)
No (NS)
No (NS)
U
U
ND
No (NS)
No (NS)
U
No (NS)
No (NS)
ND
No (NS)
No (NS)
U
U
No (NS)
Yes (NS)
No (8.1-10.1)
No (11.1-55)
ND
No (80)
ND
ND
L
U
U
No (65)
ND
ND
L
ND
ND
U
U
ND
ND
ND
U
No (11.4)
ND
ND
U
U
U
U
No (8.1)
ND
U
U
ND
No
ND
No
No
U
No
U
ND
ND
Yes
U
No
U
U
ND
No
U
U
No
U
ND
U
U
U
U
No
ND
Lepirudin
Letrozole
Leucovorin
Leuprolide
Levamisole
Levetiracetam
Levobupivacaine
Levocarnitine
Levocetirizine
Levodopa
Levooxacin
Levoleucovorin
Levomethadyl
Levonorgestrel
Levorphanol
Levosimendan
Levothyroxine
Lidocaine
Lincomycin
Linezolid
Liothyronine
Lisdexamfetamine
Lisinopril
Lithium
Lomeoxacin
Lomustine
Loperamide
Lopinavir
Loracarbef
Loratadine
No (4.3-6.2)
ND
ND
ND
ND
Yes (NS)
U
Yes (NS)
No (NS)
U
U
ND
U
U
ND
No (6.4)
U
No (NS)
No (NS)
Yes (NS)
ND
ND
Yes (NS)
Yes (NS)
No (NS)
No (NS)
ND
U
Yes (NS)
No (NS)
Yes (20-90)
ND
ND
ND
ND
L
ND
L
U
U
No (13.2)
ND
U
ND
ND
U
ND
ND
ND
Yes (9.3-65)
ND
ND
L
Yes (40, 70)
ND
ND
ND
No (NS)
L
U
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
ND
ND
ND
ND
ND
U
ND
U
U
No
ND
U
U
ND
U
U
U
No
ND
ND
ND
ND
Yes
No
U
ND
U
ND
No
37
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Lorazepam
No (NS)
ND
Losartan
No (NS)
No (10.1-52)
Lovastatin
U
U
Loxapine
ND
ND
L-tryptophan
U
No (8.1-40)
Lubiprostone
U
U
Lumefantrine
ND
ND
Mangafodipir
ND
ND
Mannitol
Yes (NS)
L
Maprotiline
No (NS)
U
Maraviroc
ND
ND
Mecamylamine
ND
ND
Mecasermin
ND
ND
Mechlorethamine
U
U
Meclofenamate
U
U
Medroxyprogesterone
U
U
Mefenamic acid
No (NS)
U
Meoquine
U
ND
Megestrol acetate
ND
ND
Meloxicam
No (NS)
U
Melphalan
No (NS)
ND
Memantine
ND
ND
Menadiol
ND
ND
Menotropins
ND
ND
Mepenzolate
ND
ND
Meperidine/
No (NS)/ND No (8.1)/Yes (8.1)
normeperidine
Meprobamate
Yes (NS)
L
Mercaptopurine
Yes (NS)
L
Meropenem
Yes (NS)
L
38
U
No
U
ND
ND
U
ND
ND
Yes
U
ND
ND
ND
U
U
U
U
U
ND
U
ND
ND
ND
ND
ND
U/ND
Yes
ND
ND
Mesalamine (5-ASA)
Mesna
Mesoridazine
Metaproterenol
Metaxalone
Metformin
Methadone
Methaqualone
Methenamine
Methicillin
Methimazole
Methocarbamol
Methohexital
Methotrexate
Methoxsalen
Methoxypolyethylene
glycol-epoetin beta
Methscopolamine
Methsuximide
Methyldopa
Methylergonovine
Methylnaltrexone
Methylphenidate
Methylprednisolone
Methysergide
Metoclopramide
Metolazone
Metoprolol
Metronidazole
Mexiletine
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Yes (5.5)
ND
U
ND
ND
Yes (NS)
No (NS)
No (NS)
ND
No (NS)
No (NS)
ND
U
Yes (NS)
ND
ND
ND
ND
ND
ND
L
U
ND
ND
U
ND
ND
U
Yes (20, 60)
ND
U
ND
U
ND
ND
ND
No
No
ND
No
No
ND
U
No
ND
ND
ND
Yes (NS)
ND
ND
U
Yes (NS)
ND
No (NS)
No (NS)
Yes (NS)
Yes (NS)
Yes (NS)
ND
ND
L
ND
ND
ND
L
ND
U
U
L
Yes (56)
L
ND
ND
Yes
ND
ND
U
ND
ND
No
U
ND
No
No
39
Drug
Mezlocillin
Micafungin
Miconazole
Midazolam
Midodrine
(de-glymidodrine)
Mifepristone
Miglitol
Miglustat
Milnacipran
Milrinone
Minocycline
Minoxidil
Mirtazapine
Misoprostol
Mitomycin
Mitotane
Mitoxantrone
Mivacurium
Modanil
Moexipril
Molindone
Montelukast
Moricizine
Moroctocog alfa
Morphine
Moxioxacin
Muromonab-CD3
Mycophenolate
(mycophenolic acid)
40
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Yes (NS)
U
No (NS)
No (NS)
L
U
U
U
No
U
No
U
ND
Yes (8.1)
ND
U
ND
ND
U
ND
No (NS)
Yes (NS)
No (7.5)
U
ND
ND
No (NS)
ND
ND
ND
U
U
U
U
ND
ND
U
U
ND
ND
U
ND
ND
L
ND
ND
ND
ND
U
ND
ND
ND
ND
ND
ND
U
Yes (8.1, 10.1)
ND
ND
U
ND
ND
U
ND
No
Yes
U
U
ND
ND
No
ND
ND
ND
U
U
U
U
No
ND
U
No (NS)
No
Nabilone
Nabumetone
Nadolol
Nadroparin
Nafarelin
Nafcillin
Nalbuphine
Nalidixic acid
Nalmefene
Naloxone
Naltrexone
Nandrolone
Naproxen
Naratriptan
Natalizumab
Nateglinide/
M1 metabolite
Nebivolol
Nedocromil
Nefazodone
Nelarabine
Nelnavir
Neomycin
Nesiritide
Netilmicin
Nevirapine
Niacin
Niacinamide
Nicardipine
Nicotine
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
No (NS)
Yes (NS)
ND
ND
No (NS)
ND
U
No (4.1-5.9)
ND
No (NS)
ND
No (NS)
ND
U
ND
U
L
ND
ND
ND
ND
U
U
ND
U
ND
U
ND
U
ND
U
ND
ND
ND
No
ND
U
U
ND
U
ND
U
ND
U
U/Yes (NS)
U/Yes (NS)
U/ND
U
ND
U
U
U
Yes (NS)
U
Yes (NS)
ND
ND
ND
No (NS)
ND
U
ND
U
U
No (71)
L
U
L
Yes (40)
ND
ND
U
ND
U
ND
U
U
No
Yes
U
Yes
Yes
ND
ND
U
ND
41
Drug
Nicotinic acid
Nifedipine
Nilotinib
Nilutamide
Nimodipine
Nisoldipine
Nitazoxanide
Nitrendipine
Nitrofurantoin
Nitroglycerin
Nitroprusside
Nizatidine
Nomifensine
Nonacog alfa
Norepinephrine
Norethindrone
Noroxacin
Norgestimate
Norgestrel
Nortriptyline
Nylidrin
Nystatin
Octreotide
Ooxacin
Olanzapine
Olmesartan
Olsalazine
Omapatrilat
Omega-3-acid ethyl
esters
42
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
No (NS)
U
ND
No (NS)
No (NS)
U
No (NS)
Yes (NS)
No (NS)
Yes (NS)
No (NS)
ND
U
ND
ND
No (NS)
U
ND
No (NS)
ND
U
Yes (NS)
Yes (6.0)
No (NS)
U
U
No (NS)
ND
U
U
ND
U
U
U
U
L
ND
L
ND
ND
U
ND
ND
ND
U
ND
U
ND
U
L
Yes (8.5)
U
No (NS)
ND
ND
ND
No
U
ND
No
No
U
U
ND
No
Yes
No
ND
U
ND
No
U
U
ND
No
ND
U
ND
No
No
U
U
ND
ND
ND
ND
Omeprazole
Ondansetron
Oprelvekin
Orboban
Orlistat
Ornidazole
Orphenadrine
Oseltamivir
Oxacillin
Oxaliplatin
Oxandrolone
Oxaprozin
Oxazepam
Oxcarbazepine
Oxtriphylline
Oxybutynin
Oxycodone
Oxymetholone
Oxymorphone
Paclitaxel
Palifermin
Paliperidone
Palivizumab
Palonosetron
Pamidronate
Pancuronium
Panitumumab
Pantoprazole
Papaverine
Para-aminosalicylate
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
U
U
U
Yes (NS)
U
Yes (NS)
ND
Yes (NS)
No (NS)
ND
U
No (NS)
No (NS)
ND
Yes (NS)
ND
ND
ND
U
No (NS)
U
ND
U
ND
Yes (6.4)
ND
U
No (5.1)
U
U
ND
ND
U
L
U
L
ND
ND
U
ND
U
ND
ND
ND
L
ND
Yes (48)
ND
U
U
ND
ND
U
ND
L
ND
U
U
U
No (30, 60)
U
U
U
ND
U
No
ND
Yes
No
ND
U
U
U
ND
No
ND
ND
ND
U
No
ND
ND
U
ND
ND
ND
U
U
U
U
43
Drug
44
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Paricalcitol
Paromomycin
Paroxetine
Peoxacin
Pegademase
Pegaspargase
Peglgrastim
Peginterferon alfa-2a
No (5.5)
ND
No (NS)
No (NS)
U
U
No (NS)
U
U
ND
Yes (NS)
No (NS)
Yes (NS)
Yes (NS)
No (NS)
Yes (NS)
No (NS)
ND
ND
U
ND
ND
U
ND
ND
U
ND
U
ND
U
No (8.7-33)
No (8.7)
Yes (20-33)
U
ND
L
ND
L
L
ND
L
ND
ND
ND
U
ND
ND
U
Peginterferon alfa-2b
Pegvisomant
Pemetrexed
Pemoline
Penbutolol
Penicillamine
Penicillin
Pentamidine
Pentazocine
Pentobarbital
Pentosan polysulfate
Pentostatin
Pentoxifylline
Perexane
Perutren
Pergolide
Perindopril
(perindoprilat)
Perphenazine
Phenacetin
Phenazopyridine
ND
ND
U
No
U
U
U
U
U
ND
No
No
ND
No
No
ND
U
ND
ND
U
ND
ND
U
Yes (NS)
ND
U
ND
ND
U
ND
ND
U
ND
ND
Phendimetrazine
Phenelzine
Phenobarbital
Phenoxybenzamine
Phentermine
Phentolamine
Phenylbutazone
Phenytoin
Phytonadione
Pilocarpine
Pimozide
Pinaverium
Pindolol
Pioglitazone
Piperacillin
Piroxicam
Pizotyline
Plerixafor
Plicamycin
Polyethylene glycol
Polythiazide
Poractant alfa
Pormer
Posaconazole
Pralidoxime
Pramipexole
Pramlintide
Prasugrel
Pravastatin
Prazepam
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
ND
Yes (NS)
ND
ND
ND
No (NS)
No (NS)
ND
ND
ND
U
ND
U
Yes (NS)
U
U
ND
ND
U
No (NS)
ND
No (NS)
No (NS)
ND
No (NS)
ND
U
No (5.3)
No (NS)
ND
ND
Yes (60)
ND
ND
ND
U
Yes (36)
ND
ND
ND
U
ND
U
L
U
U
ND
ND
U
ND
ND
U
U
ND
U
ND
U
ND
ND
ND
ND
Yes
ND
ND
ND
U
No
ND
ND
ND
U
ND
U
No
U
U
ND
ND
U
No
ND
U
U
ND
U
ND
U
ND
U
45
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Praziquantel
No (NS)
Prazosin
No (NS)
Prednisolone
U
Prednisone
No (NS)
Pregabalin
Yes (NS)
Primaquine
No (NS)
Primidone
Yes (NS)
Probenecid
U
Probucol
No (NS)
Procainamide/N-acetyl Yes (NS)/
procainamide (NAPA)
Yes (NS)
Procarbazine
ND
Prochlorperazine
U
Procyclidine
ND
Progesterone
U
Proguanil
No (NS)
Promazine
U
Promethazine
No (NS)
Propafenone
No (NS)
Propantheline
ND
Propofol
U
Propoxyphene
No (NS)
Propranolol
No (NS)
Propylthiouracil
No (NS)
Protriptyline
No (NS)
Pseudoephedrine
No (NS)
Pyrantel
ND
Pyrazinamide
Yes (NS)
Pyridostigmine
ND
Pyridoxine
ND
46
ND
U
No (NS)
ND
L
U
L
U
ND
ND
No
U
No
ND
U
ND
U
No
L/L
No/No
ND
U
ND
U
U
ND
U
U
ND
U
ND
U
ND
U
U
ND
Yes (80)
ND
Yes (36)
ND
U
ND
U
U
U
U
No
ND
U
No
No
ND
No
U
ND
No
ND
ND
Pyrilamine
Pyrimethamine
Quazepam
Quetiapine
Quinapril (quinaprilat)
Quinidine
Quinine
Quinupristin/
dalfopristin
Rabeprazole
Raloxifene
Raltegravir
Raltitrexed
Ramelteon
Ramipril (ramiprilat)
Ranibizumab
Ranitidine
Ranolazine
Rapacuronium
Rasagiline
Rasburicase
Recainam
Remifentanil
Repaglinide
Reserpine
Reteplase
Reviparin
Ribavirin
Rifabutin
Rifampin
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
ND
U
ND
No (NS)
No* (NS)
No (NS)
ND
ND
U
ND
U
U
U
ND
ND
U
ND
No
No
No
ND
ND
No/No
U
U
ND
ND
ND
No (NS)
U
No (NS)
ND
ND
ND
U
No (NS)
U
U
No (NS)
ND
No (NS)
No (NS)
U
No (NS)
U
U
ND
ND
ND
ND
U
Yes (NS)
ND
ND
ND
U
ND
U
No (60)
U
ND
ND
U
No (40)
No (80)
U
U
ND
ND
ND
ND
U
No
ND
ND
ND
U
U
U
U
No
ND
U
U
U
No
47
Drug
Rifapentine
Rifaximin
Rilmenidine
Rilonacept
Riluzole
Rimantadine
Risedronate
Risperidone
Ritodrine
Ritonavir
Rituximab
Rivastigmine
Rizatriptan
Rocuronium
Romiplostim
Ropinirole
Ropivacaine
Rosiglitazone
Rosuvastatin
Rotigotine
Roxithromycin
Ruboxistaurin
Runamide
Ruoxacin
Sacrosidase
Salsalate
Sapropterin
Saquinavir
Sargramostim
Secobarbital
48
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
U
U
No (NS)
U
U
No (NS)
ND
ND
Yes (NS)
U
No (NS)
ND
ND
ND
ND
U
U
No (NS)
No (NS)
U
ND
U
No (NS)
ND
ND
Yes (NS)
ND
U
ND
No (NS)
U
U
ND
U
U
U
ND
ND
L
No (40)
U
ND
ND
ND
ND
U
U
U
ND
U
ND
U
ND
ND
ND
L
ND
No (40)
ND
ND
U
U
U
U
U
U
ND
ND
Yes
No
U
ND
ND
ND
ND
U
U
No
U
U
No
U
U
ND
ND
No
ND
U
ND
No
Secretin
Selegiline
Sermorelin
Sertindole
Sertraline
Sevelamer
Sevourane
Sibutramine
Sildenal
Silodosin
Silver
Simethicone
Simvastatin
Sirolimus
Sisomicin
Sitagliptin
Sitaxsentan
Sodium oxybate
Sodium polystyrene
sulfonate
Solifenacin
Somatropin
Sorafenib
Sotalol
Sparoxacin
Spectinomycin
Spirapril (spiraprilat)
Spironolactone
Stanozolol
Stavudine
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
ND
ND
No (NS)
No (NS)
U
ND
U
U
U
No (NS)
U
U
No (NS)
Yes (NS)
No (NS)
U
ND
ND
ND
ND
U
U
U
ND
U
No (65)
U
ND
U
U
U
L
ND
U
ND
ND
ND
ND
U
U
U
ND
U
U
U
U
U
U
U
ND
ND
U
ND
U
No (NS)
U
Yes (NS)
ND
Yes (NS)
U
U
ND
Yes (NS)
U
U
U
L
ND
L
ND
ND
ND
Yes (NS)
U
U
U
ND
ND
Yes
U
U
ND
ND
49
Drug
Streptokinase
Streptomycin
Sucralfate
Sufentanil
Sulbactam
Sulfadiazine
Sulfadoxine
Sulfamethoxazole
Sulfapyridine
Sulfasalazine
Sulnpyrazone
Sulsoxazole
Sulindac
Sumatriptan
Sunitinib
Tacrine
Tacrolimus
Tadalal
Talinolol
Tamoxifen
Tamsulosin
Tapentadol
Tazobactam
Tebazumab
Tegaserod
Teicoplanin
Telbivudine
Telithromycin
Telmisartan
Temazepam
50
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
U
Yes (NS)
No (NS)
U
Yes (NS)
ND
ND
Yes (NS)
ND
U
No (NS)
Yes (NS)
No (NS)
ND
U
ND
No (NS)
No (NS)
No (NS)
ND
U
U
Yes (NS)
No (NS)
No (NS)
No (NS)
No (NS)
ND
No (NS)
No (NS)
U
L
ND
U
L
ND
ND
L
ND
U
U
L
ND
ND
No (NS)
ND
U
U
ND
ND
U
U
L
ND
U
ND
ND
ND
ND
U
U
Yes
No
U
No
ND
ND
No
ND
U
U
Yes
U
ND
U
ND
U
U
ND
ND
U
U
No
U
U
No
ND
ND
U
U
Temocillin
Temozolomide
Temsirolimus
Teniposide
Tenofovir
Terazosin
Terbinane
Terbutaline
Teriparatide
Testolactone
Testosterone
Tetrabenazine
Tetracycline
Thalidomide
Thallous chloride
Theophylline
Thiabendazole
Thiamine
Thiethylperazine
Thioguanine
Thioproperazine
Thioridazine
Thiotepa
Thiothixene
Thyrotropin alfa
Tiagabine
Ticarcillin
Ticlopidine
Tigecycline
Tilidine
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
Yes (NS)
ND
No (NS)
U
ND
No (NS)
U
ND
ND
ND
No (NS)
ND
No (NS)
U
ND
Yes (NS)
ND
No (NS)
ND
ND
ND
U
ND
U
U
No (NS)
Yes (NS)
U
No (NS)
No (NS)
L
ND
U
ND
Yes (50)
U
U
ND
ND
ND
U
ND
ND
No (65)
ND
L
ND
ND
ND
ND
ND
U
ND
ND
U
U
L
U
ND
ND
No
ND
U
U
ND
No
U
ND
ND
ND
U
ND
No
U
ND
No
ND
U
ND
ND
ND
U
ND
U
U
U
No
U
U
U
51
Drug
Tiludronate
Timolol
Tinidazole
Tinzaparin
Tipranavir
Tiroban
Tizanidine
Tobramycin
Tocainide
Tocopherol
Tolazamide
Tolbutamide
Tolcapone
Tolmetin
Tolterodine
Tolvaptan
Topiramate
Topotecan
Torsemide
Tositumomab
Tosuoxacin
Tramadol
Trandolapril
(trandolaprilat)
Tranexamic acid
Tranylcypromine
Trapidil
Trastuzumab
Trazodone
Treprostinil
52
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
U
No (NS)
Yes (NS)
U
U
Yes (NS)
ND
Yes (NS)
Yes (NS)
ND
U
No (NS)
U
U
U
U
Yes (NS)
Yes (8.0)
No (NS)
U
No (NS)
No (NS)
ND
ND
L
ND
U
L
ND
L
L
ND
ND
ND
U
U
U
U
L
L
U
U
ND
Yes (50)
U
No
ND
ND
U
ND
ND
Yes
ND
ND
U
U
U
U
U
U
ND
ND
U
U
ND
ND
Yes (NS)
ND
ND
ND
ND
U
U
U
ND
ND
ND
U
ND
U
ND
ND
ND
U
U
U
Tretinoin
Triamterene
Triazolam
Trientine
Triuoperazine
Triupromazine
Trihexyphenidyl
Trimeprazine
Trimethobenzamide
Trimethoprim
Trimetrexate
Trimipramine
Triprolidine
Triptorelin
Tropisetron
Trospium
Trovaoxacin
Urofollitropin
Ursodiol
Valacyclovir
Valganciclovir
Valproic acid
Valrubicin
Valsartan
Vancomycin
Vardenal
Varenicline
Vecuronium
Velosulin
Venlafaxine
I CHART
Drug
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
ND
No (NS)
ND
No (NS)
U
ND
ND
ND
Yes (NS)
U
U
ND
ND
U
ND
No (NS)
ND
U
Yes (NS)
Yes (NS)
No (NS)
ND
No (NS)
No (NS)
ND
Yes (NS)
U
U
No (NS)
ND
ND
ND
ND
U
ND
ND
ND
ND
L
U
U
ND
ND
U
ND
ND
ND
U
L
ND
Yes (62)
ND
ND
Yes (10.1-60)
ND
ND
ND
U
U
ND
ND
U
ND
No
U
ND
ND
ND
No
U
U
ND
ND
U
ND
ND
ND
U
No
ND
No
ND
U
No
ND
ND
U
U
U
53
Drug
Verapamil
Verteporn
Vigabatrin
Vinblastine
Vincristine
Vinorelbine
Voriconazole
Vorinostat
Warfarin
Zarlukast
Zalcitabine
Zaleplon
Zanamivir
Zidovudine/GZDV
Zileuton
Zinc
Ziprasidone
Zoledronic acid
Zolmitriptan
Zolpidem
Zonisamide
Zuclopenthixol
54
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
No (NS)
ND
Yes (NS)
ND
ND
ND
No (NS)
ND
No (NS)
U
ND
ND
ND
No (NS)/
Yes (NS)
U
ND
No (NS)
ND
U
No (NS)
Yes (NS)
ND
ND
ND
L
ND
ND
ND
U
ND
ND
U
ND
ND
ND
No
ND
ND
ND
ND
ND
No
ND
No
U
ND
ND
ND
ND/L
No/Yes
No (8.3, 10.1)
ND
U
ND
U
U
ND
ND
U
ND
U
ND
U
U
ND
ND
I CHART
Drugs of Abuse
Drug
Amphetamine
Cocaine
Ethanol
Heroin
Lysergide (LSD)
Marijuana (THC)
MDMA (Ecstasy)
Mescaline (peyote)
Nicotine
Phencyclidine (PCP)
Psilocybin
HEMODIALYSIS
(KUf)
(KUf)
Dialysis
ND
No (NS)
Yes (NS)
U
U
U
ND
U
ND
U
ND
ND
ND
L
ND
ND
ND
ND
ND
ND
ND
ND
ND
U
ND
U
U
U
ND
U
No
U
ND
55
References
1. Aronoff GR, Bennett WM, Berns JS, Brier ME, Kasbekar
N, Mueller BA, Pasko DA, Smoyer WE. Drug prescribing
in renal failure, 5th ed. Philadelphia: American College
of Physicians; 2007.
2. Choi G, Gomersall CD, Tian Q, Joynt GM, Freebairn
R, Lipman J. Principles of antibacterial dosing in
continuous renal replacement therapy. Crit Care Med.
2009;37:2268-2282.
3. Schetz M. Drug dosing in continuous renal
replacement therapy: general rules. Curr Opin Crit Care.
2007;13:645-651.
4. Heintz BH, Matzke GR, Dager WE. Antimicrobial
dosing concepts and recommendations for critically ill
adult patients receiving continuous renal replacement
therapy or intermittent hemodialysis. Pharmacotherapy.
2009;29:562-577.
5. Ibrahim RB, Liu C, Cronin SM, Murphy BD,
Cha R, Swerdlow P, Edwards DJ. Drug removal
by plasmapheresis: an evidence-based review.
Pharmacotherapy. 2007;27:1529-1549.
6. Keller E, Reetze P, Schollmeyer P. Drug therapy in
patients undergoing continuous ambulatory peritoneal
dialysis: Clinical pharmacokinetic considerations. Clin
Pharmacokinet. 1990;18:104-117.
7. Keller F, Bhler J, Czock D, Zellner D, Mertz AKH.
Individualized drug dosage in patients treated with
continuous hemofiltration. Kidney Int. 1999;56 (Suppl
72):S-29- S31.
8. Bugge JF. Pharmacokinetics and drug dosing
adjustments during continuous venovenous
hemofiltration or hemodiafiltration in critically ill
patients. Acta Anaesthesiol Scand. 2001;45:929-934.
9. Olyaei AJ, Bennett WM. Principles of drug usage in
dialysis patients, in Nissenson AR, Fine RN (eds).
Handbook of Dialysis Therapy (4th ed). Philadelphia:
Saunders Elsevier; 2008.
10. Taylor CA, Abdel-Rahman E, Zimmerman SW, Johnson
CA. Clinical pharmacokinetics during continuous
ambulatory peritoneal dialysis. Clin Pharmacokinet.
1996;31:293-308.
56

Dialysis of Drugs: Curtis A. Johnson, Pharmd

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Curtis A. Johnson, PharmD

2010 Dialysis of Drugs

DISCLAIMERThese Dialysis of Drugs guidelines

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

What Determines Drug

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

Because the primary binding proteins for most

2010 Dialysis of Drugs

patients, renal clearance is largely replaced by

Blood and Dialysate Flow Rates

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

achieved with faster dialysate flow rates that keep

2010 Dialysis of Drugs

and high-efficiency cuprammonium rayon

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

continuous venovenous hemodiafiltration

2010 Dialysis of Drugs

of the body stores of such drugs are outside the

Predicted Measured Condition Filter

Predicted Measured Condition Filter

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

Predicted Measured Condition Filter

Amicon dialter (polysulfone)

The specific CRRT technique employed will

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

frequent replacement doses. Drug removal can

2010 Dialysis of Drugs

aspects of the dialysis system. Published

About This Guide

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I ABOUT THIS GUIDE

No indicates that dialysis does not have a

2010 Dialysis of Drugs

available on drug dialyzability. In some cases, the

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs