20 to 50     : Dose as in normal renal function but use with caution
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                :Not dialysed. Dose as in normal renal function.
HD                             :Not dialysed. Dose as in normal renal function.
HDF/high flux   :Unknown dialysability. Dose as in normal renal function.
CAV/VVHD      :Not dialysed. Dose as in normal renal function
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
ACE inhibitors and angiotensin-II antagonists: antagonism of hypotensive effect; increased risk of nephrotoxicity and hyperkalaemia
Analgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin (increased side effects); avoid with ketorolac (increased risk of side effects and haemorrhage)
Antibacterials: possible increased risk of convulsions with quinolones
Anticoagulants: effects of coumarins enhanced; possible increased risk of bleeding with heparins and coumarins
Antidepressants: increased risk of bleeding with SSRIs and venlafaxine
Antidiabetic agents: effects of sulphonylureas enhancedAnti-epileptics: possibly increased phenytoin concentration
Antivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavir
Ciclosporin: may potentiate nephrotoxicity
Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinib
Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect, hyperkalaemia with potassium-sparing diureticsLithium: excretion decreased
Pentoxifylline: increased risk of bleeding
Tacrolimus: increased risk of nephrotoxicity
ADMINISTRATION
Reconstition
–
Route
Oral
Rate of Administration
–
Comments
OTHER INFORMATION
Use with caution in uraemic patients predisposed to gastrointestinal bleeding or uraemic coagulopathies
Inhibition 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 therapy – if raised, discontinue NSAID therapy
Use normal doses in patients with ESRD on dialysis if they do not pass any urine
Use with great caution in renal transplant recipients; it can reduce intrarenal autocoid synthesis