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                : Unknown dialysability. Dose as in normal renal function
HD                     : Dialysed. Dose as in normal renal function
HDF/high flux   : Dialysed. Dose as in normal renal function
CAV/VVHD      : Unknown dialysability. Dose as in normal renal function
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Analgesics: increased risk of nephrotoxicity with NSAIDs; antagonism of diuretic effect
Anti-arrhythmics: hypokalaemia leads to increased cardiac toxicity; effects of lidocaine and mexiletine antagonised
Antibacterials: avoid administration with lymecycline
Antidepressants: increased risk of hypokalaemia with reboxetine; enhanced hypotensive effect with MAOIs; increased risk of postural hypotension with tricyclics
Anti-epileptics: increased risk of hyponatraemia with carbamazepine
Antifungals: increased risk of hypokalaemia with amphotericin Antihypertensives: enhanced hypotensive effect; increased risk of first dose hypotension with post-synaptic alpha- blockers like prazosin; hypokalaemia increases risk of ventricular arrhythmias with sotalol
Antipsychotics: 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 use
Atomoxetine: hypokalaemia increases risk of ventricular arrhythmias Cardiac glycosides: increased toxicity if hypokalaemia occurs
Ciclosporin: increased risk of nephrotoxicity and possibly hypomagnesaemia Lithium 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 Diuresis starts within 1–2 hours, peaks at 4–6 hours and lasts for almost 24 hours Manufacturer advises to avoid in severe renal impairment due to reduced clearance