20 to 50     : Dose as in normal renal function
10 to 20     : Dose as in normal renal function
<10           : Dose as in normal renal function
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                : Unlikely to be dialysed. Dose as in normal renal function
HD                     : Unlikely to be dialysed. Dose as in normal renal function
HDF/high flux   : Unknown dialysability. Dose as in normal renal function
CAV/VVHD      : Unlikely to be dialysed. Dose as in normal renal function
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Anti-epileptics: phenytoin levels may be reduced
Antifungals: metabolism possibly inhibited by itraconazole and posaconazole (increased risk of neurotoxicity)
Antipsychotics: avoid concomitant use with clozapine (increased risk of agranulocytosis)
ADMINISTRATION
Reconstition
–
Route
IV
Rate of Administration
Slow bolus
Comments
May be administered into fast running drip of sodium chloride 0.9% or glucose 5%
OTHER INFORMATION
Most of an IV dose is excreted into the bile after rapid tissue binding Metabolised by cytochrome P450 (in the CYP 3A subfamily). Elimination is primarily biliary; excreted into bile and faeces (67% within 72 hours, 40–50% as metabolites), 10% excreted in urine in 24 hrs