DialyzeIHD: Dialyzability of Medications During Intermittent Hemodialysis

% Dialyzed IHD Dosing; Administration % Dialyzed % Dialyzed IHD Dosing; Administration % Dialyzed IHD Dosing; Administration Timing
IHD Dosing; Administration Drug
Drug (Type of Drug (Type of
Timing Around HD Session
Drug (Type of (Type of
Around HD Session
Timing Around HD Session Dialyzer) Dialyzer) Timing Around HD Session Dialyzer)
Dialyzer)

Not recommended for use, 0.25-0.5mg PO Q8H PRN, Insulin Aspart, Pentamidine 0 4mg/kg IV Q24-36H,
Acarbose N/A Clonazepam N/A Reduce to 25-50% of normal dose Isethionate (N/A) Administer anytime during HD
Administer anytime during HD Administer anytime during HD Insulin Detemir,
N/A and titrate, Administer anytime
Insulin Glargine,
100-150mg PO Q12-24H, 0.1-0.4mg PO Q8-12H, during HD Normal dose and titrate based on
Acebutolol N/A <5 Insulin Lispro
Administer post-HD Clonidine Administer anytime during HD; No target free or corrected total
(Low Flux) Phenytoin
Dose post-HD if hypotensive 75-300mg PO Q24H, (Low Flux) phenytoin level,
Normal dose based on indication, 0 Administer anytime during HD
Acetaminophen N/A 75mg PO Q24H, Irbesartan Administer anytime during HD; Dose
Administer anytime during HD Clopidogrel N/A (N/A)
Administer anytime during HD post-HD if hypotensive No 15-45mg PO Q24H,
Pioglitazone
2.5-5mg/kg IV/PO Q24H, (N/A) Administer anytime during HD
40-60 250-500mg PO Q6H or 1-2g IV Q4- 100mg IV weekly to monthly,
Acyclovir Administer post-HD over 60 Cloxacillin N/A Iron Dextran N/A
(N/A) 6H, Administer anytime during HD Administer anytime during HD Piperacillin/ 10-65 2.25g-4.5g IV Q12H,
minutes (Low Flux) Administer post-HD over 30 minutes
Tazobactam
Reduce to 50% of normal dose and 100mg IV weekly to monthly,
Normal dose based on blood work, Iron Sucrose N/A
Alfacalcidol N/A titrate, Administer post -HD Administer anytime during HD 0 Normal dose based on indication,
Administer anytime during HD Codeine N/A Posaconazole
(if given on HD, may require (N/A) Administer anytime during HD
0.25-0.5mg PO Q8H PRN, supplemental dose post -HD) Isosorbide Minimal 5-40mg PO Q8H,
Alprazolam N/A Dinitrate (N/A) Administer post-HD 10-80mg PO Q24H,
Administer anytime during HD 22-36.7 Reduce to 75% of normal dose Pravastatin N/A
Administer post-HD
2-5 100mg PO Q7days, Cyclophosphamide (over 3- 4 hrs) based on indication, 0 100-200mg PO Q24H,
Amantadine (Low Flux) Administer post-HD over 20-60 min Itraconazole Minimal 1-5mg PO Q8-12H,
(Low Flux) Administer anytime during HD (High Flux) Administer anytime during HD Prazosin
(N/A) Administer anytime during HD
Dose based on indication and
LD 5-7.5mg/kg IV, then MD 5mg/kg <1 AVOID if possible; 10mg PO Q12H,
Cyclosporine target serum level, Ketorolac N/A Normal dose based on indication,
18.5-88 IV QHD (Once daily dosing NOT (Low Flux) Administer anytime during HD Prednisone N/A
Amikacin Administer anytime during HD Administer anytime during HD
(Low Flux) recommended), Administer post-
HD (or over last 10 minutes of HD) 68 AVOID use, 100-400mg PO Q12H, 80-160mg PO Q12H,
Dabigatran <1
(N/A) Not recommended Labetalol Administer anytime during HD; Dose Propranolol <5 (N/A) Administer anytime during HD; Dose
Minimal Normal dose based on indication, (Low Flux)
Amiodarone post-HD if hypotensive post-HD if hypotensive
(N/A) Administer anytime during HD 100mg PO Q24H,
Dapsone N/A
Administer anytime during HD 17 Normal dose based on indication, 2.5-10mg PO Q24H,
Minimal 2.5-10mg PO Q24H, Lamotrigine 12
Amlodipine (N/A) Administer post-HD Quinapril Administer anytime during HD; Dose
(N/A) Administer anytime during HD 6mg/kg IV QHD, (Low Flux)
39-58 post-HD if hypotensive
Daptomycin Administer post-HD over 10 Normal dose based on blood work,
30-47 500mg PO Q24H, (High Flux) Lanthanum N/A
Amoxicillin minutes Administer anytime during HD Yes 200-300mg PO HS or on HD,
(Low Flux) Administer post-HD Quinine
No (N/A) Administer anytime during HD
0.45mcg/kg/week IV/SC initially, LD 500mg IV/PO, then 250-500mg
0 Normal dose based on indication, Darbepoetin (High & Low 10-21 Minimal 1.25-5mg PO Q24H,
Amphotericin B Administer anytime during HD Levofloxacin IV/PO Q48H, Administer post-HD
(High Flux) Administer anytime during HD Flux) (High Flux) Ramipril
over 60 minutes (Low Flux) Administer post-HD
5mg/kg/week IV,
13-27 0 Dose based on indication,
Amphotericin B 0 5mg/kg IV Q24H Deferoxamine Administer post-HD or during last 32-37 600mg IV/PO Q12H, Rituximab
(Low Flux) Linezolid (N/A) Administer anytime during HD
Lipid Complex (High Flux) Administer anytime during HD hour of HD (Low Flux) Administer post-HD over 30 minutes
Normal dose based on indication, 5-40mg PO Q24H,
Diazepam N/A 51 2.5-10mg PO Q24-48H, Rosuvastatin N/A Administer anytime during HD
1000mg IV Q12H, Administer anytime during HD Lisinopril
35-40 (Low Flux) Administer post-HD
Ampicillin Administer post-HD Dose based on blood work,
(Low Flux) AVOID if possible; 25mg PO Q12H, Sevelamer N/A
(or last 10 minutes of HD) Diclofenac N/A Reduce to 25-50% of normal dose; Administer anytime during HD
Administer anytime during HD Yes
Lithium titrate based on target serum level,
50-100 81-325mg PO Q24H (varies based (N/A) Minimal 10-40mg PO Q24H,
ASA LD 0.5-0.75mg (if required), then Administer post-HD Simvastatin
(N/A) on indication), Administer post-HD (N/A) Administer anytime during HD
Digoxin N/A MD 0.0625mg PO QHD,
75 25mg PO Q24H, Administer anytime during HD 8 0.5-1mg PO Q8H PRN,
Atenolol Lorazepam 0 Normal dose based on target serum
(Low Flux) Administer post-HD (Low Flux) Administer anytime during HD Sirolimus
120-360mg PO Q24H (sustained (N/A) level, Administer anytime during HD
Minimal 10-80mg PO Q24H, release), Administer anytime 50-100mg PO Q24H,
Atorvastatin Diltiazem N/A 0 Sodium Ferric <1 125mg IV weekly to monthly,
(N/A) Administer anytime during HD during HD; Dose post-HD if Losartan Administer anytime during HD; Dose
hypotensive (High Flux) Gluconate (N/A) Administer anytime during HD
post-HD if hypotensive
Reduce to 50% of normal dose 12.5-25mg IV thrice weekly,
45 25-50mg PO/IV/SC Q8H PRN >32
Azathioprine based on indication, Dimenhydrinate N/A 50-70 500-1000mg IV Q24H, Sodium Thiosulfate Administer post-HD over 30-60
(N/A) Administer anytime during HD Meropenem (High Flux)
Administer post-HD (Low Flux) Administer post-HD over 15 minutes minutes
250-500mg PO or 500mg IV Q24H, 25-50mg PO/IV/SC Q6H PRN
Azithromycin N/A Diphenhydramine N/A Reduce to 50-75% of normal dose 20 40mg PO Q24H,
Administer anytime during HD Administer anytime during HD 1-18 Sotalol
Methadone and titrate, Administer anytime (low Flux) Administer post-HD
(Low Flux)
LD 1000mg IV, then 500mg IV Dose based on indication and during HD
1-2g IV Q72-96H,
40 Q12H, target free valproic acid level, Streptomycin N/A
Aztreonam 63 AVOID use, Administer post-HD
(Low Flux) Administer post-HD over 20 Administer post-HD, if feasible . Methotrexate
Divalproex N/A (High Flux) Not recommended
minutes For seizure indication, administer Not recommended; 800/160mg
Q12H but may require Sulfamethoxazole/ (Double Strength tablet) PO or 2.5-
60 250mg PO Q12-24H, 2-57
Normal dose based on indication, supplemental dose post-HD. Methyldopa Trimethoprim 10mg/kg TMP IV daily, Administer
Basiliximab N/A (N/A) Administer post-HD (N/A)
Administer anytime during HD (SMX/TMP) post-HD over 30-60 min
1-8mg PO Q24H,
Minimal Methyl- 5-20 Normal dose based on indication,
2.5-5mg PO Q24H, Doxazosin Administer anytime during HD;
Normal dose based target serum level,
Bisoprolol N/A (Low Flux) (N/A)
Administer post-HD Dose post-HD if hypotensive prednisolone Administer post-HD Tacrolimus N/A
Administer anytime during HD
<8 6 100mg IV/PO Q12-24H, 5mg PO/IV Q6H, Administer anytime
Normal dose based on blood work, Doxycycline 2-51 20-80mg PO Q24H,
Calcitriol (High & Low (N/A) Administer anytime during HD Metoclopramide during HD; (if given on HD, may 0
Administer anytime during HD (Low Flux) Telmisartan Administer anytime during HD; Dose
Flux) require supplemental dose post-HD) (N/A)
400mg PO Q12H, post-HD if hypotensive
Dronedarone N/A
Calcium Normal dose based on blood work, Administer anytime during HD 12.5-200mg Q12H, 15-30mg PO HS PRN,
Acetate, As phosphate binder, administer Temazepam N/A
N/A 38-57 2.5-10mg PO Q24-48H, Metoprolol N/A Administer anytime during HD; Dose Administer anytime during HD
Calcium with meals; As supplementation, Enalapril post-HD if hypotensive
(Low Flux) Administer post-HD
Carbonate administer post-HD 1-20mg PO QHS,
Terazosin N/A
No 25-45 500mg IV/PO Q 8-12H, Administer anytime during HD
100units/kg/week IV/SC initially, Metronidazole
Normal dose based on blood work Epoetin alfa (High & Low (Low Flux) Administer post-HD over 20 minutes
Calcium Administer anytime during HD Not recommended; 125mg PO Q24H,
and indication, Flux) Terbinafine N/A
Gluconate Likely Yes 100-150mg IV Q24H, Administer anytime during HD
Administer anytime during HD; 500mg IV Q24H, Micafungin N/A
Infusion 30 Administer anytime during HD
Dose post-HD if feasible Ertapenem Administer post-HD over 30 250-500mg PO Q24H,
(N/A) Tetracycline N/A
minutes 2.5-10mg PO PRN intradialytic Administer anytime during HD
4-32mg PO Q24H, Yes
0 Midodrine hypotension,
Candesartan Administer anytime during HD; 0-7 250-500mg PO Q12H, (N/A) 0 LD 100mg IV, then 50mg IV Q12H,
(High Flux) Erythromycin Administer at the start of HD Tigecycline
Dose post-HD if hypotensive (Low Flux) Administer anytime during HD (N/A) Administer anytime during HD
40 12.5-50mg PO Q24H, 10mg PO Q24H, Likely 2.5-80mg PO in 1-2 divided doses, LD 2mg/kg IV, then MD 1-1.5mg/kg IV
Captopril Ezetimibe N/A Minoxidil 50 QHD (Once daily dosing NOT
(High Flux) Administer post-HD Administer anytime during HD (N/A) Administer post-HD
Tobramycin
(Low Flux) recommended), Administer post-HD
Normal dose based on indication, AVOID use, AVOID if possible; Reduce to 50% of (or last 10 minutes of HD)
Fenofibrate N/A
titrate according to target serum Not recommended 23-51 normal dose and titrate, Administer
9 (Low Flux) level; Administer post-HD, if 0.25-2g PO Q24H, start with low dose
Carbamazepine Normal dose based on pain Morphine (High & Low post -HD (if given on HD, may
28 (High Flux) feasible. For seizure indication, 0 Flux) require supplemental dose post - Tolbutamide N/A and titrate,
Fentanyl requirement, Administer anytime during HD
administer Q12H but may require (High Flux) HD)
Administer anytime during HD
supplemental dose post-HD. 25-100mg Q12-24H (50% of normal
Ferrous Gluconate, 400mg IV/PO Q24H, dose), Administer post-HD
3.125-25mg PO Q12H, Normal dose based on blood work, Moxifloxacin N/A Topiramate N/A
Ferrous Sulfate, N/A Administer anytime during HD (if given on HD, may require
Carvedilol N/A Administer anytime during HD; Administer anytime during HD
Dose post-HD if hypotensive Ferrous Fumarate supplemental dose post-HD)
Mycophenolate No 1-1.5g PO Q12H,
5mcg/kg SC Q24H, Mofetil (Low Flux) Administer anytime during HD 50-100mg PO Q12H PRN (immediate
LD 70mg IV, then MD 35mg IV Filgrastim N/A
Caspofungin N/A Q24H, Administer anytime during HD release tablets ONLY),
0.25-2mg PO Q12H, 55
Administer anytime during HD Nabilone N/A Tramadol Administer post-HD (if given on HD,
100-200mg IV/PO Q24H, (High Flux)
40-63 Administer anytime during HD may require supplemental dose post-
1-2g IV QHD, Fluconazole Administer post-HD (rate:
(N/A) HD)
27-50 200mg/hr) N/A 40mg PO QHD,
Cefazolin Administer post-HD Nadolol
(High Flux) (Low Flux) Administer post-HD 0.5-2mg PO Q24H or 2mg QHD (thrice
(or last 10 minutes of HD) Readily 37.5mg/kg PO QHD, Minimal
Flucytosine Trandolapril weekly), Administer anytime during
(Low Flux) Administer post-HD 0.4-2mg IV PRN, (N/A)
0 200mg PO Q24H, Naloxone N/A HD; Dose post-HD if hypotensive
Cefixime Administer anytime during HD
(Low Flux) Administer post-HD 40-80mg IV/PO Q8-24H (based on
Minimal 0-44 100mg PO Q24H,
Furosemide requirement), Trimethoprim
1-2g IV Q24H, (N/A) No AVOID if possible; 250mg PO Q12H, (N/A) Administer post-HD
39-60 Administer anytime during HD Naproxen
Cefotaxime Administer post-HD (Low Flux) Administer anytime during HD
(Low Flux) 33-45 500mg PO Q24H,
(or last 10 minutes of HD) 100-300mg PO HS, Valacyclovir
35 Administer post-HD (if given on HD, 60-180mg PO Q8H AC, (N/A) Administer post-HD
1-2g IV QHD, Gabapentin Nateglinide N/A Start with low dose and titrate,
13.7 (Low Flux) may require supplemental dose Dose based on indication and target
Cefoxitin Administer post-HD post -HD) Administer anytime during HD
(Low Flux) free valproic acid level, Administer
(or last 10 minutes of HD) 37-57
LD 2mg/kg IV, then MD 1- 250mg PO Q24H and titrate to Valproic Acid post-HD, if feasible. For seizure
Minimal (High Flux)
1-2g IV QHD, 1.5mg/kg IV QHD (Once daily Niacin 500mg PO Q8H, indication, administer Q12H but may
41-81 38-60 (High Flux)
Ceftazidime Administer post-HD Gentamicin dosing NOT recommended), Administer anytime during HD require supplemental dose post-HD.
(High Flux) (High Flux)
(or last 10 minutes of HD) Administer post-HD (or over last 10
80-320mg PO Q24H,
minutes of HD) 30-90mg PO Q24H (sustained 0
21-24 1-2g IV Q12-24H, 2 Valsartan Administer anytime during HD; Dose
Ceftriaxone 40-160mg PO Q12H, Nifedipine release), (N/A)
(High Flux) Administer anytime during HD (Low Flux) post HD if hypotensive
Gliclazide N/A Start with low dose and titrate, Administer anytime during HD
750-1500mg IV Q24H, Administer anytime during HD LD 25mg/kg, then MD IV QHD,
Cefuroxime 18-25 Normal dose based on indication,
Administer post-HD Administer post-HD or during the last
Sodium (Low Flux) 0.25-2mg IV/IM once, based on Nitroglycerin N/A varies with dosage form, Administer
(or last 10 minutes of HD) No part of HD
Glucagon indication, post–HD, if feasible MD for patient 80kg or less: 500mg IV
AVOID if possible; 100mg PO Q24H, (N/A) 23-38
Celecoxib N/A Administer anytime during HD Vancomycin QHD over last 30 min of HD;
Administer anytime during HD 8mg PO/IV Q8H PRN, (High Flux)
No AVOID use, Ondansetron N/A MD for patient more than 80kg: 750mg
Glyburide Administer anytime during HD
51 250-500mg PO Q12H, (N/A) Not recommended IV QHD over last 60 min of HD;
Cephalexin For higher doses, see PDTM for
(Low Flux) Administer post-HD Treatment: 75mg PO QHD x 5 days;
25-50mg PO Q8-16H, infusion time
53-70 Prophylaxis: 30mg PO Q24H on day
4-8g PO Q12-24H, Hydralazine N/A Administer anytime during HD; Oseltamivir
Cholestyramine N/A (N/A) 1, then 30mg QHD
Administer anytime during HD Dose post-HD if hypotensive 180-480mg PO Q24H (sustained
Administer post-HD
Minimal release),
30-180mg PO Q24H, Normal dose based on indication, Verapamil
Cinacalcet N/A Hydrocortisone N/A 1-2 10-30mg PO HS, (Low Flux) Administer anytime during HD; Dose
Administer anytime during HD Administer anytime during HD Oxazepam
(Low Flux) Administer anytime during HD post HD if hypotensive
250-750mg PO or 200-400mg IV Reduce to 50% of normal dose and
23-31 Hydromorphone N/A titrate, Reduce to 50% of normal dose, Vitamin B & C 1 tablet PO Q24H
Ciprofloxacin Q24H, Administer post-HD Yes
(Low Flux) Administer anytime during HD 33-53 Administer post-HD (if given on HD, (Renavite) Administer post-HD
(or last 10 minutes of HD) Oxycodone
(Low Flux) may require supplemental dose post 400 units PO Q24H
4-17 AVOID if possible; 300mg PO Q8H, Vitamin E N/A
250-500mg PO Q24H, Ibuprofen -HD) Administer anytime during HD
Clarithromycin N/A (Low Flux) Administer anytime during HD
Administer post-HD
250-500mg IV Q12H, 1-4 million units IV Q12-18H, 200mg PO Q12H (IV not
0 150-600mg PO or 600mg IV Q8H, 21-90 Penicillin G N/A Administer post-HD over 30 10
Clindamycin Imipenem/Cilastatin Administer post-HD over 30 Voriconazole recommended),
(Low Flux) (Low Flux) minutes (High Flux)
Administer anytime during HD minutes Administer anytime during HD
No Normal dose based on indication, 20 AVOID if possible; 25mg PO Q12H, 300mg PO Q12H, Administer post- No 5-15mg PO HS PRN;
Clobazam Indomethacin Penicillin V N/A Zopiclone
(Low Flux) Administer anytime during HD (Low Flux) Administer anytime during HD HD (Low Flux) Administer anytime during HD
HD – Hemodialysis, High Flux – Kuf >20mL/hour/mmHg, Low Flux - Kuf <10mL/hour/mmHg, Kuf – Ultrafiltration coefficient (measure of filtration capacity), LD – Loading Dose, MD- Maintenance Dose, N/A – not available Prepared by Polly Kwok, B. Sc. (Pharm); Marianna Leung, PharmD; Fong Huynh, PharmD Acknowledgements: Kevin Chiu, Michael Chan, Gary Peng