DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unknown dialysability. Dose as in GFR <10 mL/min
HD                     :Dialysed. Dose as in GFR <10 mL/min . (Give 800 mg dose after dialysis sessios)
HDF/high flux   :Dialysed. Dose as in GFR <10 mL/min . (Give 800 mg dose after dialysis session)
CAV/VVHD      :Dialysed. Dose as in GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Antibacterials: concentration reduced by rifampicin – avoid during and for 2 weeks after rifampicin therapy
Antidepressants: concentration reduced by St John’s wort – avoid during and for 2 weeks after St John’s wort therapy
Anti-epileptics: concentration reduced by carbamazepine, phenytoin, phenobarbital and primidone – avoid during and for 2 weeks after treatment
Antifungals: avoid in combination with ketoconazole in severe renal and hepatic impairment
Antipsychotics: increased risk of ventricular arrhythmias with pimozide – avoid concomitant use
Antivirals: avoid concomitant use with amprenavir, atazanavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir and tipranavir in severe renal and hepatic impairmentAnxiolytics and hypnotics: inhibits metabolism of midazolam (increased sedation)
Diuretics: increased eplerenone concentration – avoid concomitant useTelithromycin and ergot derivatives should not be co-administered due to possibility of ergotismIvabradine: possibly increased ivabradine concentration – avoid concomitant useLipid-regulating drugs: increased risk of myopathy with atorvastatin and simvastatin – avoid concomitant useSirolimus: increased sirolimus levels – avoid concomitant use
Tacrolimus: possibly increased tacrolimus levels
ADMINISTRATION
Reconstition
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Route
Oral
Rate of Administration
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Comments
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OTHER INFORMATION
Do not give to people at risk of QT interval prolongation due to its potential to prolong the QT intervalOral bioavailability is approximately 57% after a single dose of 800 mgIn patients with renal and hepatic impairment the dose should be reduced to 400 mg dailyMonitor for signs of liver toxicity AUC increased 2-fold if GFR<30 mL/min .