20 to 50     : Dose as in normal renal function, but avoid if possible
10 to 20     : Dose as in normal renal function, but avoid if possible
<10           : Dose as in normal renal function, but only if on dialysis
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Removal very unlikely. Dose as in GFR <10 mL/min.
HD                     :Removal very unlikely. Dose as in GFR <10 mL/min.
HDF/high flux   :Unknown dialysability. Dose as in GFR <10 mL/min.
CAV/VVHD      :Removal very unlikely. Dose as in GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsACE inhibitors and angiotensin-II antagonists: antagonism of hypotensive effect; increased risk of nephrotoxicity and hyperkalaemia
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 (risk of lithium toxicity)
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
OTHER INFORMATION
NSAIDs have been reported to cause nephrotoxicity in various forms; interstitial nephritis, nephrotic syndrome and renal failure. In patients with renal, cardiac or hepatic impairment, caution is required since the use of NSAIDs may result in deterioration of renal functionInhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of existing renal disease – avoid if possible; if not, check serum creatinine 48–72 hours after starting NSAID – if creatinine has increased, discontinue therapyUse normal doses in patients with ERF on dialysis if they do not pass any urineUse with caution in renal transplant recipients – can reduce intrarenal autocoid synthesis.