20 to 50     : Dose as in normal renal function
10 to 20     : Dose as in normal renal function
<10           : Unlikely to work
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unlikely to be dialysed. Unlikely to work.
HD                     :Not dialysed. Unlikely to work
HDF/high flux   :Unknown dialysability. Unlikely to work
CAV/VVHD      :Probably not dialysed. Unlikely to work
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Analgesics: increased risk of nephrotoxicity with NSAIDs; antagonism of diuretic effect
Anti-arrhythmics: hypokalaemia leads to increased cardiac toxicity; effects of lidocaine and mexiletine antagonised
Antibacterials: avoid administration with lymecycline
Antidepressants: increased risk of hypokalaemia with reboxetine; enhanced hypotensive effect with MAOIs; increased risk of postural hypotension with tricyclics
Anti-epileptics: increased risk of hyponatraemia with carbamazepine
Antifungals: increased risk of hypokalaemia with amphotericinAntihypertensives: enhanced hypotensive effect; increased risk of first dose hypotension with post-synaptic alpha-blockers like prazosin; hypokalaemia increases risk of ventricular arrhythmias with sotalol
Antipsychotics: hypokalaemia increases risk of ventricular arrhythmias with amisulpride or sertindole; enhanced hypotensive effect with phenothiazines; hypokalaemia increases risk of ventricular arrhythmias with pimozide – avoid concomitant use
Atomoxetine: hypokalaemia increases risk of ventricular arrhythmias
Cardiac glycosides: increased toxicity if hypokalaemia occurs
Ciclosporin: increased risk of nephrotoxicity and hypomagnesaemia
Lithium excretion reduced, increased toxicity
ADMINISTRATION
Reconstition
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Route
Oral
Rate of Administration
–
Comments
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OTHER INFORMATION
Monitor for hypokalaemia Thiazide diuretics are unlikely to be of use once GFR<30 mL/min