30–50 Dose as in normal renal function 10–30 Reduce total dose by 50% and administer daily
<10           : Reduce total dose by 50% and administer daily
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                : Not dialysed. 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      : Not dialysed. Dose as in GFR=10–30 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Analgesics: increased risk of bleeding with aspirin and NSAIDs
Anticoagulants: effects of warfarin possibly enhanced
Antidepressants: avoid concomitant use with MAOIs and moclobemide (increased risk of toxicity); possibly enhanced serotonergic effects with duloxetine
Antimalarials: avoid concomitant use with artemether/lumefantrine
Antipsychotics: increases concentration of clozapine and haloperidol
Dopaminergics: use entacapone with caution; increased risk of hypertension and CNS excitation with selegiline – avoid concomitant use
Sibutramine: increased risk of CNS toxicity – avoid concomitant use
ADMINISTRATION
Reconstition
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Route
Oral
Rate of Administration
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Comments
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OTHER INFORMATION
Withhold dose until after haemodialysis to minimise nausea and any other side effects May be used to treat peripheral diabetic neuropathy in haemodialysis patients; dose is up to 75 mg daily. www.medscape.com/ viewarticle/440202 An ECG is required before treatment .