20 to 50     : Start at a low dose and gradually increase
10 to 20     : Start at a low dose and gradually increase
<10           : Start at a low dose and gradually increase
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Likely dialysability. Dose as in GFR <10 mL/min
HD                     :Likely dialysability. Dose as in GFR <10 mL/min
HDF/high flux   :Likely dialysability. Dose as in GFR <10 mL/min
CAV/VVHD      :Likely dialysability. Dose as in GFR=10-20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsMuscle relaxants: enhances effect of suxamethonium; antagonises effect of non-depolarising muscle relaxants