10 to 20     : mg/kg/day in 2 divided doses1
HD                     :Not dialysed. Dose as in GFR <10 mL/min
HDF/high flux   :Unknown dialysability. Dose as in GFR <10 mL/min
CAV/VVHD      :Unlikely to be dialysed. Dose as in GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Anti-arrhythmics: increased risk of ventricular arrhythmias with disopyramide and lidocaine – avoid concomitant useAnxiolytics and hypnotics: increased concentration of midazolam (risk of profound sedation); metabolism of zopiclone inhibited
Calcium-channel blockers: increased concentration of nifedipine
Ciclosporin: increased levels of ciclosporin
Ergot alkaloids: avoid concomitant use with ergotamine and methysergide
Tacrolimus: tacrolimus levels increased by 15%
ADMINISTRATION
Reconstition
With 5 mL glucose 5% or water for injection
Route
IV infusion
through a central line
Rate of Administration
Over 60 minutes
Comments
Central access is recommended: Dilute reconstituted solution further in —100 mL glucose 5% for central access Or 250 mL for peripheral access (for —emergency administration of 1st dose only). Stable for 5 hours at room temperature and 24 hours if refrigeratedIncompatible with saline solutions
OTHER INFORMATION
After the infusion, flush the line with glucose 5% to minimise venous irritationHas been administered intraperitoneally at a dose of 25 mg/L in alternate bags, in combination with intravenous treatmentSynercid is an inhibitor of CYP 3A4: caution is recommended when co-administering any drug also metabolised by this route