DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsAnalgesics: increased risk of nephrotoxicity with NSAIDs; antagonism of diuretic effectAnti-arrhythmics: hypokalaemia leads to increased cardiac toxicity; effects of lidocaine and mexiletine antagonisedAntibacterials: avoid administration with lymecyclineAntidepressants: increased risk of hypokalaemia with reboxetine; enhanced hypotensive effect with MAOIs; increased risk of postural hypotension with tricyclicsAnti-epileptics: increased risk of hyponatraemia with carbamazepineAntifungals: increased risk of hypokalaemia with amphotericinAntihypertensives: enhanced hypotensive effect; increased risk of first dose hypotension with post-synaptic alpha-blockers like prazosin; hypokalaemia increases risk of ventricular arrhythmias with sotalolAntipsychotics: hypokalaemia increases risk of ventricular arrhythmias with amisulpride or sertindole; enhanced hypotensive effect with phenothiazines; hypokalaemia increases risk of ventricular arrhythmias with pimozide – avoid concomitant useAtomoxetine: hypokalaemia increases risk of ventricular arrhythmiasCardiac glycosides: increased toxicity if hypokalaemia occursCiclosporin: increased risk of nephrotoxicity and possibly hypomagnesaemiaLithium: excretion reduced, increased toxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Monitor for hypokalaemia Acts within 1–3 hours, peaks in 4–8 hours and lasts up to 12 hours