20 to 50     : Dose as in normal renal function. Use with care
10 to 20     : Initial dose 60 mg once or twice daily. ‘See Other Information’
<10           : Initial dose 60 mg once daily. See ‘Other Information’
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unlikely dialysability. Dose as in GFR <10 mL/min
HD                     :Not dialysed. Dose as in GFR <10 mL/min
HDF/high flux   :Unknown dialysability. Dose as in GFR <10 mL/min
CAV/VVHD      :Unlikely to be dialysed. Dose as in GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsAluminium/magnesium containing antacids: reduced absorption – avoid for 2 hours
ADMINISTRATION
Reconstition
–
Route
Oral
Rate of Administration
–
Comments
Take before food
OTHER INFORMATION
Less than 1.5% of a dose is metabolised via the CP450 3A4 systemLarger doses may be used in patients with renal impairment, but increase carefully as can result in increased sedation