20 to 50     : Start with low dose, but avoid if possible
10 to 20     : Start with low dose, but avoid if possible
<10           : Start with low dose, but only use if on dialysis
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unlikely to be dialysed. Start with low doses and increase according to response.
HD                     :Not dialysed. Start with low doses and increase according to response. See ‘Other Information’
HDF/high flux   :Not dialysed. Start with low doses and increase according to response. See ‘Other Information’
CAV/VVHD      :Not dialysed. Dose as in GFR 10 to 20 mL/min .
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsACE Inhibitors and angiotensin- II antagonists: increased risk of hyperkalaemia and nephrotoxicity; reduced hypotensive effect
Analgesics: avoid concomitant use with other NSAIDs or aspirin; avoid concomitant use with ketorolac (increased side effects and haemorrhage)
Antibacterials: possibly increased risk of convulsions with quinolones
Anticoagulants: effects of coumarins enhanced; possibly increased risk of bleeding with heparins and coumarins
Antidepressants: increased risk of bleeding with SSRIs or venlafaxineAntidiabetic agents: effects of sulphonylureas enhanced
Anti-epileptics: possibly enhanced effect of phenytoin
Antivirals: concentration possibly increased by ritonavir; increased risk of haematological toxicity with zidovudine
Ciclosporin: may potentiate nephrotoxicity Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinib
Lithium: excretion reduced
Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect; hyperkalaemia with potassium-sparing diureticsPentoxifylline: increased risk of bleeding
Tacrolimus: increased risk of nephrotoxicity
ADMINISTRATION
Reconstition
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Route
Oral
Rate of Administration
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Comments
–.FEnoProFEn 301
OTHER INFORMATION
Contraindicated in patients with history of significantly impaired renal functionInhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of existing renal disease – avoid use if possible; if not, check serum creatinine 48–72 hours after starting NSAID – if it has increased, discontinue therapyPossibility of decreased platelet aggregationCan use normal doses in patients with ERF on dialysisUse with caution in renal transplant recipients – can reduce intrarenal autocoid synthesisAssociated with nephrotic syndrome, interstitial nephritis, hyperkalaemia, sodium retention