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TABLE 57-4 -- Drug Doses in Renal Failure
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Acarbose D 100% Avoid Avoid Unknown Unknown Avoid
Acebutolol D 100% 50% 3050% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Acetaminoph
en
I q4h q6h q8h Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Acetazolamid
e
I q6h q12h Avoid No data No data Avoid
Acetohexami
de
I Avoid Avoid Avoid Avoid Avoid Avoid
Acetohydroxa
mic Acid
D 100% 100% Avoid Unknown Unknown Unknown
Acetylsalicycl
ic Acid
I q4h q46h Avoid As normal
GFR
As normal
GFR
As normal
GFR
Dose post
HD
Acrivastine D 8 mgq12h 8 mg q12
24h 8 mg q24h Dose asGFR < 10 Dose asGFR < 10 Dose asGFR 10
50
Aciclovir D, I 5
mg/kg
q8h
5 mg/kg
q1224h
2.5 mg/kg
q24h
Dose as
GFR < 10
Dose as
GFR < 10
3.5
mg/kg/day
Dose post
HD
Adenosine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Albuterol D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Alfentanil D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Allopurinol D 75% 50% 33% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Alprazolam D 100% 100% 100% Unknown Unknown NA
Alteplase (t-PA)
100% 100% 100% As normalGFR
As normalGFR
As normalGFR
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Altretamine D Unknown Unknown Unknown No data No data Unknown
Amantadine I q24
48h
q4872h q7d Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Amikacin D, I 60
90%
q12h
3070%
q1218h
2030%
q2448h
5 mg/kg
post HD
1520
mg/L/day
Dose as
GFR 10
50
Amiloride D 100% 50% Avoid NA NA NA
Aminophylline D 100% 200
400mg q12h 200
300mg q12h Dose asGFR < 10 Dose asGFR < 10 Dose asGFR 10
50
Amiodarone D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Amitriptyline D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Amlodipine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Amoxapine D 100% 100% 100% Unknown Unknown NAAmoxicillin I q8h q812h q24h Dose as
GFR < 10
250 mg
q8h
As normal
GFR
Dose post
HD
Amphotericin I q24h q24h q2436h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Amphotericin
B Colloidal
I q24h q24h q2436h Dose as
GFR < 10
Dose as
GFR < 10
Dose for
GFR 1050
Amphotericin
B lipid
I q24h q24h q2436h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Ampicillin I q6h q612h q1224h Dose as
GFR < 10
Dose as
GFR < 10
Dose as G
FR 1050
Dose post
HD
Amrinone D 100% 100% 5075% No data No data Dose asGFR 10
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
50Anistreplase D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Astemizole D 100% 100% 100% Unknown Unknown NA
Atenolol D, I 100%
q24h
100%
q24h
50% q24h Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Atovaquone 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Atracurium D 100% 100% 100% As normalGFR
As normalGFR
As normalGFR
Auranofin D 36 mg
q24h
3 mg q24h Avoid Avoid Avoid Dose as
GFR 10
50
Azathioprine D 100% 75% 50% As normal
GFR
Dose as
GFR < 10
Dose as
GFR 10
50
Azithromycin D 100% 100% 100% No data No data No data
Azlocillin I q46h q68h q8h Dose asGFR < 10
Dose forGFR < 10
Dose asGFR 10
50
Dose post
HD
Aztreonam D 100% 5075% 25% Dose as
GFR < 10
Dose for
GFR < 10
Dose as
GFR 10
50
Dose post
HDBasiliximab 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Benazepril D 100% 5075% 2550% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Betamethason
e
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Betaxolol D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Bezafibrate D 70% 50% q24
48h Avoid 200 mgq72h 200 mgq72h Dose asGFR 10
50
Bisoprolol D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Bleomycin D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Bopindolol D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 1050
Bretylium D 100% 2550% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Bromocriptin
e
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Bromphenira
mine
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Budesonide D 100% 100% 100% As normalGFR
As normalGFR
As normalGFR
Bumetanide D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Bupropion D 100%
q24h
100%
q24h
100%
q24h
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Buspirone D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
50% if
anuric
50% if
anuric
Busulfan D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Butorphanol D 100% 75% 50% Unknown Unknown NA
Capreomycin I q24h q24h q48h Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
50Dose post
HD
Cefmetazole I q16h q24h q48h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
Cefonicid D, I 0.5 g/d 0.1 g0.5
g/day
0.1 g/day Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Ceforanide I q12h q1224h q2448h 0.51.0 g
post HD
None 1.0 g/day
Cefotaxime I 100%
q8h
100% q8h 50% q8
12h
Dose as
GFR < 10
1 g q24h 1 g q12h
Dose post
HD
Cefotetan D 100% 50% 25% 250500
mg q24h
1 g q24h 750 mg
q12h+500 mg
post HD
Cefoxitin I 100% 12 g q8
24h
0.51 g
q1224h
0.51 g
q2448h
1 g q24h Dose as
GFR 10
50
+1 g post
HD
Cefpodoxime I 100% 100% 100200
mg
Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFRq2448h
Cefprozil D, I 100% 50% q24h 50% q24h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR < 10
Dose post
HD
Ceftazidime I 100% 0.51 g
q1224h
0.51 g
q48h
1 g post
HD
0.51 g
q24h
0.51 g
q12h
Ceftibuten D 100% 50% 25% 400 mg
post HD
Dose as
GFR < 10
Dose as
GFR 10
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
50Ceftizoxime I 0.51.5
g q8h
0.251 g
q12h
0.250.5 g
q24h
0.250.5 g
q24h
0.51.0 g
q24h
Dose as
GFR 10
50
Dose post
HD
Ceftriaxone D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Dose post
HDCefuroxime
axetil (oral)
D 100% 100% 250 mg
q24h
Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Dose post
HD
Cefuroxime
(iv)
100% 0.751.5 g
q812h
750 mg
q12h
750 mg
q24h
750 mg
q24h
Dose as
GFR 10
50
Dose post
HDCeliprolol D 100% 100% 75% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Cephalexin I 250
500 mg
q6h
250500
mg q812h
250500
mg
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
q1224h Dose post
HD
Cephalothin I q6h q68h q12h Dose as
GFR < 10
Dose as
GFR < 10
1 g q8h
Dose post
HD
Cephapirin I q6h q68h q12h Dose as
GFR < 10
Dose as
GFR < 10
1 g q8h
Dose post
HD
Cephradine D 100% 50% 25% Dose as
GFR < 10
Dose for
GFR < 10
As normal
GFR
Dose post
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
dialysisCetirizine D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Chloralhydrat
e
D 100% Avoid Avoid Avoid Avoid Avoid
Chlorambucil D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Chlorampheni
col
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Chlorazepate D 100% 100% 100% Unknown Unknown NA
Chlordiazepo
xide
D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Chloroquine D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Chlorphenira
mine
D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Chlorpromazi
ne
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Chlorpropami
de
D 50% Avoid Avoid Avoid Avoid Avoid
Chlorthalidon
e
I 100% 100% Avoid Avoid Avoid NA
Cholestyrami
ne
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Cibenzoline D, I 100%
q12h
100%
q12h
66% q24h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Cidofovir D 50
100%
Avoid Avoid No data No data Avoid
Cilastin D 100% 50% Avoid Avoid Avoid Avoid
Cilazapril D, I 75%
q24h
50% q24
48h
1025%
q72h
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Cimetidine D 100% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Cinoxacin D 100% 50% Avoid Avoid Avoid AvoidCiprofloxacin D 100% 5075% 50% 250 mg
q12h
250 mg
q8h
200 mg IV
q12h
Cisapride D 100% 50% 50% Dose as
GFR < 10
Dose as
GFR < 10
50100%
Cisplatin D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Cladribine D Unkno
wn
Unknown Unknown Unknown Unknown Unknown
Clarithromyci
n
D 100% 75% 5075% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
Clavulanic
acid
D 100% 100% 5075% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose postHD
Clindamycin D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Clodronate D 100% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Clofazimine 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
No data
Clofibrate I q612h q1218h Avoid Dose asGFR < 10
Dose asGFR < 10
Dose asGFR 10
50
Clomipramin
e
D 100% Start at lower dose and
monitor effect
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Clonazepam D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Clonidine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Codeine D 100% 75% 50% Dose as Dose as Dose as
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
GFR < 10 GFR < 10 GFR 10
50
Colchicine D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Colestipol D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Cortisone D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Cyclophosphamide D 100% 75
100% 50
75% Dose asGFR < 10 Dose asGFR < 10 Dose asGFR 10
50
Cycloserine I q12h q1224h q24h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Cyclosporine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Cytarabine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dapsone 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Daunorubicin D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Delavirdine 100% 100% 100% Dose as
GFR < 10
No data Dose as
GFR 10
50Desferrioxam
ine
D 100% 100% 50% Unknown Unknown Dose as
GFR 10
50
Desipramine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
NA
Dexamethaso
ne
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Diazepam D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 1050
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Diazoxide D 100% 100% 100% Dose asGFR < 10 Dose asGFR < 10 Dose asGFR 10
50
Diclofenac D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Dicloxacillin D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
NA
Didanosine I 100% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Diflunisal D 100% 50% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Digitoxin D 100% 100% 5075% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Digoxin D, I 100%
q24h
2575%
q36h
1025%
q48h
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dilevalol D 100% 100% 100% Dose asGFR < 10
Dose asGFR < 10
Unknown
Diltiazem D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Diphenhydra
mine
D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dipyridamole D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Dirithromycin 100% 100% 100% Dose asGFR < 10
Dose asGFR < 10
Dose asGFR 10
50
Disopyramide I q8h q12h q2440h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dobutamine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Doxacurium D 100% 50% 50% Unknown Unknown Dose as
GFR 1050
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Doxazosin D 100% 100% 100% As normalGFR As normalGFR As normalGFR
Doxepin D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Doxorubicin D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Doxycycline D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Dyphylline D 75% 50% 25% dose Unknown Dose as
GFR 10
50
Ebastine D 100% 50% 50% Unknown Unknown Dose as
GFR 10
50
Enalapril D 100% 75100% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Epirubicin D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Erythromycin D 100% 100% 5075% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Estazolam D 100% 100% 100% Unknown Unknown NA
Etanercept 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Ethambutol I q24h q2436h q48h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
Ethchlorvynol D 100% Avoid Avoid Dose as
GFR < 10
Dose as
GFR < 10
NA
Ethionamide D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Ethosuximide D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Etodolac D 100% 100% 100% As normal As normal Dose as
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
GFR GFR GFR 10
50
Etomidate D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Etoposide D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Famciclovir I 100% q1248h 50% q48h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
Famotidine D 100% 50% 20 mg
q24h
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Fazadinium D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Felodipine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Fenoprofen D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Fentanyl D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Fexofenadine I q12h q1224h q24h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Flecainide D 100% 75% 50% Dose asGFR < 10
Dose asGFR < 10
Dose asGFR 10
50
Fleroxacin D 100% 50% 50% 400 mg
post HD
400
mg/24h
Dose as
GFR 10
50
Fluconazole D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Dose post
HD
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Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Flucytosine I q12h q16h q24h Dose asGFR < 10 0.5/24h Dose asGFR 10
50
Dose post
HD
Fludarabine D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Flumazenil D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Flunarizine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Fluorouracil D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
Fluoxetine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 1050
Flurazepam D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Flurbiprofen D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Flutamide D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFRFluvastatin D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Fluvoxamine D 100% 100% 100% Dose as
GFR < 10
Unknown NA
Foscarnet D 28
mg/kg/
q8h
15
mg/kg/q8h
6
mg/kg/q8h
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
7/26/2019 Brenner Adjustmen Dose
15/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Fosinopril D 100% 100% 75
100% Dose asGFR < 10 Dose asGFR < 10 Dose asGFR 10
50
Furosemide D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Gabapentin D, I 400 mg
q8h
300 mg
q1224h
300 mg
q48h
300 mg
load then
Dose as
GFR < 10
Dose as
GFR 10
50
200 mg
post HD
Gallamine D 75% Avoid Avoid NA NA Dose as
GFR 10
50
Ganciclovir I 2.55
mg/kg
q12h
1.252.5
mg/kg
q24h
1.25
mg/kg
q24h
Dose as
GFR < 10
Dose as
GFR < 10
2.5 mg/kg
q24h
Dose post
HD
Gemfibrozil D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 1050
Gentamicin D, I 60
90%
q812h
3070%
q12h
2030%
q2472h
Dose as
GFR < 10
34
mg/L/day
Dose as
GFR 10
50
Dose post
HD
Glibornuride D Unkno
wn
Unknown Unknown Unknown Unknown Avoid
Gliclazide D 100% 2040mg/day
2040mg/day
Dose asGFR < 10
Dose asGFR < 10
Dose asGFR 10
50
Glipizide D 100% 100% Contraindi
cated
Dose as
GFR < 10
Dose as
GFR < 10
Avoid
Glyburide D Unkno
wn
Avoid Avoid Avoid Avoid Avoid
Gold Sodium
Thiomalate
D 50% Avoid Avoid Dose as
GFR < 10
Dose as
GFR < 10
Avoid
Griseofulvin D 100% 100% 100% As normal As normal As normal
7/26/2019 Brenner Adjustmen Dose
16/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
GFR GFR GFRGuanabenz D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Guanadrel I q12h q1224h q2448h Unknown Unknown Dose as
GFR 10
50
Guanethidine I q24h q24h q2436h Unknown Unknown Avoid
Guanfacine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Haloperidol D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Heparin D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Hexobarbital D 100% 100% 100% Dose as
GFR < 10
Unknown NA
Hydralazine I q8h q8h q8
16h Dose asGFR < 10 Dose asGFR < 10 Dose asGFR 10
50
Hydrocortiso
ne
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Hydroxyurea D 100% 50% 20% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Hydroxyzine D 100% Unknown Unknown 100% 100% 100%
Ibuprofen D 100% 100% 100% As normalGFR
As normalGFR
Dose asGFR 10
50
Idarubicin Unkno
wn
Unknown Unknown Unknown Unknown Unknown
Ifosfamide D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Iloprost D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
7/26/2019 Brenner Adjustmen Dose
17/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Imipenem D 100% 50% 25% Dose asGFR < 10 Dose asGFR < 10 Dose asGFR 10
50
Dose post
HD
Imipramine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Indapamide D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
NA
Indinavir 100% 100% 100% Dose asGFR < 10 Dose asGFR < 10 Dose asGFR 10
50
Indobufen D 100% 50% 25% Unknown Unknown NA
Indomethacin D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Infliximab 100% No data No data No data No data No data
Insulin
(soluble)
D Variabl
e
Variable Variable Variable Variable Variable
Ipratropium D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Isoniazid D 100% 100% 75% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Dose post
HD
Isosorbide D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Dose postHD
Isradipine D 100% 100% 100 As normal
GFR
As normal
GFR
As normal
GFR
Itraconazole D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Kanamycin D, I 60
90%
q812h
3070%
q12h
2030%
q2448h
normal
dose
1520
mg/L/day
Dose as
GFR 10
50
Ketamine D 100% 100% 100% Unknown Unknown Dose as
7/26/2019 Brenner Adjustmen Dose
18/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
GFR 10
50
Ketanserin D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Ketoconazole D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Ketoprofen D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Ketorolac D 100% 50% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Labetolol D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Lamivudine D, I 100% 50150 mg
qd
25 mg qd Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose postHD
Lamotrigine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Lansoprazole D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Lepirudin 0.4
mg/kg
bolus
50% bolus Avoid Dose as
GFR < 10
Dose as
GFR < 10
50% bolus
0.15
mg/kg/
h
1530% 15%
Levodopa D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Levofloxacin D 100% 50% 2550% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Lidocaine D 100% 100% 100% Dose asGFR < 10
Dose asGFR < 10
Dose asGFR 10
7/26/2019 Brenner Adjustmen Dose
19/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
50Lincomycin I q6h q612h q1224h Dose as
GFR < 10
Dose as
GFR < 10
NA
Linezolid D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Caution
Lisinopril D 100% 5075% 2550% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50Lispro Insulin D Variabl
e
Variable Variable Variable Variable Variable
Lithium
carbonate
D 100% 5075% 2550% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
Lomefloxacin D 100% 5075% 50% Dose as
GFR < 10
Dose as
GFR < 10
NA
Loracarbef I q12h q24h q35d Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
Lorazepam D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Losartan D 100% 100% 100% 25 mg/24h
and titrate
25 mg/24h
and titrate
Dose as
GFR 1050
Lovastatin D 100% 100% 100% Unknown Unknown Dose for
GFR
Low-
molecular-
weight
heparin
D 100% Prophylact
ic dose
only
Prophylact
ic dose
only
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Maprotiline D 100% 100% 100% Unknown Unknown NA
Meclofenamic acid
D 100% 100% 100% Dose asGFR < 10
Dose asGFR < 10
Dose asGFR 10
7/26/2019 Brenner Adjustmen Dose
20/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
50Mefenamic
acid
D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Mefloquine 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Melphalan D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Meperidine D 100% 75% 50% Avoid Avoid Avoid
Meprobamate I q6h q912h q1218h Dose as
GFR < 10
Dose as
GFR < 10
NA
Meropenem D, I 500 mg
q6h
250500
mg q12h
250500
mg q24h
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
Metaproterenol D 100% 100% 100% Unknown Unknown Dose asGFR 10
50
Metformin D 50% Avoid Avoid Avoid Avoid Avoid
Methadone D 100% 100% 5075% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Methenamine
Mandelate
D 100% Avoid Avoid NA NA NA
Methicillin I q46h q68h q812h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 1050
Methimazole D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Methotrexate D 100% 50% Contraindi
cated
Contraindi
cated
Contraindi
cated
Dose as
GFR 10
50
Methyldopa I q8h q812h q1224h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
7/26/2019 Brenner Adjustmen Dose
21/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Dose postHD
Methylpredni
solone
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Dose post
HD
Metocloprami
de
D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
5075%
Metocurine D 75% 50% 50% Unknown Unknown Dose as
GFR 10
50
Metolazone D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Metoprolol D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Metronidazol
e
D 100%
q812h
100% q8
12h
100%
q12h
As normal
GFR
Dose as
GFR < 10
As normal
GFR
Dose postHD
Mexiletine D 100% 100% 5075% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Mezlocillin I q46h q68h q8h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Miconazole D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Midazolam D 100% 100% 50% Dose asGFR < 10
Dose asGFR < 10
As normalGFR
Midodrine 510
mg q8h
510 mg
q8h
2.510 mg
q8h
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Miglitol D 50% Avoid Avoid Unknown Unknown Avoid
Milrinone D 100% 100% 50 to 75% No data No data Dose as
GFR 10
50
Minocycline D 100% 100% 100% None None Dose asGFR 10
7/26/2019 Brenner Adjustmen Dose
22/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
50Minoxidil D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Mitomycin C D 100% 100% 75% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Mitoxantrone D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Mivacurium D 100% 50% 50% Dose asGFR < 10 Dose asGFR < 10 Dose asGFR 10
50
Moricizine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Morphine D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Moxalactam I q812h q1224h q2448h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 1050
Dose post
HD
Mycophenola
te mofetil
D 100% 50100% 50100% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Nabumetone D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
N-Acetylcystein
e
D 100% 100% 75% Dose asGFR < 10
Dose asGFR < 10
100%
Nadolol D 100% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
Nafcillin D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 1050
7/26/2019 Brenner Adjustmen Dose
23/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Nalidixic acid D 100% Avoid Avoid Avoid Avoid AvoidNaloxone D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Naproxen D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Nefazodone D 100% 100% 100% Unknown Unknown NA
Nefopam D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50Nelfinavir No
data
No data No data No data No data No data
Neostigmine D 100% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Netilmicin D, I 50
90%
q812h
2060%
q24h
10% q24h 2 mg/kg
post each
IV: 2
mg/kg
q48h
Dose as
GFR 10
50
HDsession IP: 7.5
10mg/LPE
Nevirapine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Nicardipine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Nicotinic acid D 100% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Nifedipine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Nimodipine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Nisoldipine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Nitrazepam D 100% 100% 100% Dose as Dose as As normal
7/26/2019 Brenner Adjustmen Dose
24/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
GFR < 10 GFR < 10 GFRNitrofurantoi
n
D Avoid Contraindi
cated
Contraindi
cated
Contraindi
cated
Contraindi
cated
Contraindi
cated
Nitroglycerin
e
D 100% 100% 100% No data No data Dose as
GFR 10
50
Nitroprusside D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Nitrosoureas D 100% 75% 25
50% Dose asGFR < 10 Unknown Unknown
Nizatidine D 75% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Norfloxacin I q12h q1224h Avoid NA NA NA
Nortriptyline D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Ofloxacin D 100% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Omeprazole D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Ondansetron D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Orphenadrine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Oxaprozin D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 1050
Oxatomide D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
NA
Oxazepam D 100% 100% 75% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Oxcarbazepin
e
D 100% 100% 100% Unknown Unknown Unknown
Paclitaxel D 100% 100% 100% As normalGFR
As normalGFR
Dose asGFR 10
7/26/2019 Brenner Adjustmen Dose
25/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
50Pancuronium D 100% 50% Avoid Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Paroxetine D 100% 5075% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Paraamino
salicylic acid
(PAS)
D 100% 5075% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose after
dialysis
Penbutolol D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Penicillamine D 100% Avoid Avoid 125250
mg thrice
weekly
post HD
Avoid Avoid
Penicillin G D 100% 75% 2050% Dose asGFR < 10
Dose asGFR < 10
Dose asGFR 10
50
Penicillin VK D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
NA
Dose post
HD
Pentamidine I q24h q2436h q48h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50Pentazocine D 100% 75% 50% Dose as
GFR < 10
Unknown Dose as
GFR 10
50
Pentobarbital D 100% 100% 100% Dose as
GFR < 10
Unknown Dose as
GFR 10
50
Pentopril D 100% 5075% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Pentoxifylline D 100% 100% 100% Unknown Unknown 100%
7/26/2019 Brenner Adjustmen Dose
26/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Pefloxacin D 100% 100% 100% Dose asGFR < 10 Dose asGFR < 10 Dose asGFR 10
50
Perindopril D 100% 75% 50% 2550% Unknown Dose as
GFR 10
50
Phenelzine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Phenobarbital I q812h q812h q1216h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Phenylbutazo
ne
D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Phenytoin D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Pindolol D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Pioglitazone D 100% 100% 100% with
caution
As normal
GFR withcaution
As normal
GFR withcaution
As normal
GFR withcaution
Pipecuronium D 100% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Piperacillin I q46h q68h q8h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HDPiretanide D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
NA
Piroxicam D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Plicamycin D 100% 75% 50% Unknown Unknown Unknown
Pravastatin D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Prazepam D 100% 100% 100% Unknown Unknown NA
7/26/2019 Brenner Adjustmen Dose
27/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Prazosin D 100% 100% 100% As normalGFR As normalGFR As normalGFR
Prednisolone D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Dose post
HD
Prednisone D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Pregabalin D 100%q812h 50% q8
12h 25% q24h Dose asGFR < 10 Dose asGFR < 10 No data
Extra dose
post HD
Primaquine 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Primidone I q8h q812h q1224h dose Unknown Unknown
Probenecid D 100% Avoid Avoid Avoid Avoid Avoid
Probucol D 100% 100% 100% Unknown Unknown Dose asGFR 10
50
Procainamide I q4h q612h Avoid Avoid Avoid Avoid
Promethazine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Propafenone D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Propofol D 100% 100% 100% As normalGFR
As normalGFR
As normalGFR
Propoxyphen
e
D 100% 100% Avoid Avoid Avoid NA
Propranolol D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Propylthioura
cil
D 100% 75% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
7/26/2019 Brenner Adjustmen Dose
28/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Protryptyline D 100% 100% 100% Dose asGFR < 10 Dose asGFR < 10 NA
Pyrazinimide D 100% As normal
GFR
As normal
GFR
As normal
GFR
As normal
GFR
As normal
GFR
Pyridostigmin
e
D 50% 35% 20% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Pyrimethamin
e
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Quazepam D Unknown Unknown Unknown Unknown Unknown NA
Quinapril D 100% 75100% 50% Dose as
GFR 10
50
Dose as
GFR < 10
Dose as
GFR 10
50
Quinidine D 100% 100% 100% Dose as
GFR < 10
As normal
GFR
As normal
GFR
Quinine I q8h q812h q24h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose post
HD
Ramipril D 100% 5075% 2550% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Ranitidine D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Ribavirin D 100% 100% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 1050
Dose post
HD
Rifabutin 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Rifampin D 100% 50100% 50100% Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Ritonavir 100% 100% 100% As normal As normal As normal
7/26/2019 Brenner Adjustmen Dose
29/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
GFR GFR GFRRituximab 100% 100% Use
with
caution
100% Use
with
caution
100% Use
with
caution
100% Use
with
caution
100% Use
with
caution
Rosiglitazone D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Saquinavir 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Secobarbital D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
NA
Sertraline D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Simvastatin D 100% 100% 10 mg
q24h
Dose as
GFR < 10
Dose as
GFR < 10
As normal
GFR
Sodium
valproate
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Sotalol D 100% 2550% Avoid Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50Sparfloxacin D, I 100% 5075% 50% q48h Dose as
GFR < 10
No data Dose as
GFR 10
50
Spectinomyci
n
D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Spironolacton
e
I q612h q1224h Avoid Dose as
GFR < 10
Dose as
GFR < 10
Avoid
Stavudine D, I 100% 50% q1224h
50% q24h Dose asGFR < 10
Dose asGFR < 10
Dose asGFR 10
50
Dose post
HD
Streptokinase D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Streptomycin I q24h q2472h q7296h 750 mg 2
3/week
2040
mg/L/day
Dose as
GFR 10
50
Streptozotoci D 100% 75% 50% Unknown Unknown Unknown
7/26/2019 Brenner Adjustmen Dose
30/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
nSuccinylcholi
ne
D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Sufentanil D 100% 100% 100% Unknown Unknown Dose as
GFR 10
50
Sulbactam I q68h q1224h q2448h Dose as
GFR < 10
0.751.5
g/day
750 mg
q12h
Dose postHD
Sulfamethoxa
zole
I q12h q18h q24h 1 g after
dialysis
1 g/day Dose as
GFR 10
50
Sulfinpyrazon
e
D 100% 100% Avoid None None Dose as
GFR 10
50
Sulfisoxazole I q6h q812h q1224h 2 g after
dialysis
3 g/day NA
Sulindac D 100% 50100% 50100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Sulotroban D 50% 30% 10% Unknown Unknown Unknown
Tacrolimus 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Tamoxifen D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Tazobactam D 100% 75% 50% Dose asGFR < 10
Dose asGFR < 10
Dose asGFR 10
50
Teicoplanin I q24h q4872h q72h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Temazepam D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Teniposide D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
7/26/2019 Brenner Adjustmen Dose
31/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
50Terazosin D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Terbutaline D 100% 50% Avoid Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Terfenadine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Tetracycline I q812h q1224h q24h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Thiazides D 100% 100% Avoid Dose as
GFR < 10
Dose as
GFR < 10
NA
Thiopental D 100% 100% 75% NA NA NA
Ticarcillin D, I 12 g
q4h
12 g q8h 12 g q12h 3 g after
dialysis
Dose as
GFR < 10
Dose as
GFR 10
50
Ticlopidine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Tigecycline 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Timolol D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Tobramycin D, I 60
90%
q812h
3070%
q12h
2030%
q2448h
normal
dose
34
mg/L/day
Dose as
GFR 10
50
Tolazamide D 100% 100% 100% Unknown Unknown Avoid
Tolbutamide D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Avoid
Tolmetin D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Topiramate D 100% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
7/26/2019 Brenner Adjustmen Dose
32/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
Topotecan D 75% 50% 25% No data No data No dataTorsemide D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
NA
Tramadol D 100% 50100 mg
q612h
50 mg
q12h
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Tranexamic
acid
D 50% 25% 10% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Tranylcypromine D Unknown Unknown Unknown Unknown Unknown NA
Trazodone D 100% 100% Avoid/50
%
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Triamcinolon
e
D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Triamterene I q12h q12h Avoid Avoid Avoid Avoid
Triazolam D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
NA
Trihexypheni
dyl
D Unkno
wn
Unknown Unknown Unknown Unknown Unknown
Trimethadion
e
I q8h q812h q1224h Unknown Unknown Dose as
GFR 10
50
Trimethoprim I q12h 50% q18h 50% q24h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Dose postHD
Trimetrexate D 100% 50100% Avoid No data No data No data
Trimipramine D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
NA
Tripelennami
ne
D Unkno
wn
Unknown Unknown Unknown Unknown NA
Triprolidine D Unkno
wn
Unknown Unknown Unknown Unknown NA
Tubocurarine D 75% 50% Avoid Unknown Unknown Dose as
7/26/2019 Brenner Adjustmen Dose
33/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
GFR 10
50
Urokinase D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Valganciclovi
r
D 50
100%
450 mg
q2448h
450 mg
BiW
Avoid Avoid 450 mg
q48h
Vancomycin D, I 500 mg
q612h
500 mg
q1248h
500 mg
q4896h
Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Vecuronium D 100% 100% 100% As normalGFR As normalGFR As normalGFR
Venlafaxine D 100% 50% 50% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Verapamil D 100% 100% 100% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Vidarabine D 100% 100% 75% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Infuse post
HD
Vigabatrin D 100% 50% 25% Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Vinblastine D 100% 100% 100% 100% 2
3/week
As normal
GFR
As normal
GFR
Dose post
HD
Vincristine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Vinorelbine D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Warfarin D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Zafirlukast D 100% 100% 100% As normal
GFR
As normal
GFR
As normal
GFR
Zalcitabine I 100% q12h q24h Dose as No data Dose as
7/26/2019 Brenner Adjustmen Dose
34/34
Drug
Dose
Meth
od
GFR >
50
(mL/mi
n)
GFR 10
50
(mL/min)
GFR < 10
(mL/min) HD CAPD CRRT
GFR < 10 GFR 10
50
Dose post
HD
Zidovudine
(AZT)
D, I 100%
q8h
100% q8h 50% q12h Dose as
GFR < 10
Dose as
GFR < 10
Dose as
GFR 10
50
Zileuton 100% 100% 100% Dose as
GFR < 10
Unknown Dose as
GFR 10
50
CAPD, chronic ambulatory peritoneal dialysis; CRRT, continuous renal replacement
therapies; HD, hemodialysis; GFR, glomerular filtration rate; D, decreasing individual doses;
I, increasing individual doses; NA, not applicable.
