20 to 50     : Dose as in normal renal function
10 to 20     : Dose as in normal renal function
<10           : 250 mg 4 times a day
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      : Unlikely to be dialysed. Dose as in GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Anticoagulants: possibly enhance anticoagulant effect of coumarins and phenindione
Oestrogens: possibly reduce contraceptive effects of oestrogens (risk probably small)
Retinoids: possible increased risk of benign intracranial hypertension with retinoids – 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
10% is removed by haemodialysis and 7% by peritoneal dialysis Avoid if possible in renal impairment due to its potential nephrotoxicity and increased risk of azotaemia, hyperphosphataemia and acidosis May cause an increase in blood urea which is dose related Avoid in SLE .