20 to 50     : Dose as in normal renal function
10 to 20     : 4.5 g every 8–12 hours, or 2.25 g every 6 hours
<10           : 4.5 g every 12 hours, or 2.25 g every 8 hours
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Not dialysed. Dose as in GFR
<10           : mL/minute
HD                     :Dialysed. Dose as in GFR
<10           : mL/minute
HDF/high flux   :Dialysed. Dose as in GFR
<10           : mL/minute
CAV/VVHD      :Dialysed. Dose as in GFR=10–20 mL/minute, or 2.25 g every 6 hours,1 or 4.5 g every 12 hoursCVVhd/HDFDialysed: 2.25–3.375 g every 6 hours,1 or 4.5 g every 8 hours
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsReduced excretion of methotrexate – monitor methotrexate levels during concomitant treatmentEnhanced action of vecuronium and similar neuromuscular blocking agents
ADMINISTRATION
Reconstition
Reconstitute each 4.5 g with 20 mL sterile water for injection or sodium chloride 0.9%
Route
IV
Rate of Administration
IV bolus over 3–5 minutes
IV infusion
over 20–30 minutes
Comments
May be given as an infusion in glucose 5% or sodium chloride 0.9%
OTHER INFORMATION
Sodium content is 2.79 mmol/g of injectionHas been used intraperitoneally for treatment of PD peritonitis at a concentration of 250 mg/LPatients with renal impairment are at a greater risk of neuromuscular excitability or convulsions that are associated with overdoseMay cause in vitro inactivation of aminoglycosides6–21% is removed by peritoneal dialysis and 30–50% by haemodialysis plus an extra 5% as the metabolite
