Kidney dose adjustment

Renal function impairment Emtricitabine and tenofovir disoproxil fumarate are principally eliminated by the kidney. Dosing interval adjustment is recommended in all patients with Ccr 30 to 49 mL/min do not administer the combination to patients with Ccr less than 30 mL/min or patients requiring hemodialysis. 

Nafcillin is primarily cleared by biliary excretion. Oxacillin, dicloxacillin, and cloxacillin are eliminated by both the kidney and biliary excretion no dosage adjustment is required for these drugs in renal failure. Because clearance of penicillins is less efficient in the newborn, doses adjusted for weight alone result in higher systemic concentrations for longer periods than in the adult. 

Cefazolin is the only first-generation parenteral cephalosporin still in general use. After an intravenous infusion of 1 g, the peak level of cefazolin is 90-120 mcg/mL. The usual intravenous dosage of cefazolin for adults is 0.5-2 g intravenously every 8 hours. Cefazolin can also be administered intramuscularly. Excretion is via the kidney, and dose adjustments must be made for impaired renal function. 

A pharmacokinetic (PK) study in individuals with impaired renal function is recommended when renal impairment is likely significantly to alter the disposition of a drug/or its active metabolite(s) such that a dose adjustment may be needed. In the main, this is the case primarily for drags that are mainly eliminated (excretion and/or metabolism) by the kidneys and/or if a drug has a narrow therapeutic window. However, severe re-... 

It undergoes glucuronide conjugation and is eliminated by the kidneys. Patients with significant renal impairment may require a dose adjustment. The half-life (9.3 1.8 hours) is shorter in patients taking enzyme-inducing drugs. The relationship between dose and serum concentration is linear. It does not autoinduce its own metabolism. 

Golper TA, Marx MA. Drug dosing adjustments during continuous renal replacement therapies. Kidney Int 1998 53(suppl 66) S165-8. 

Ganciclovir is an acyclic nucleoside analogue of guanine that is structurally similar to acyclovir, but is more effective in the treatment and prophylaxis of severe cytomegalovirus infection in immunocompromised hosts. Ganciclovir is myelotoxic, but has no significant nephrotoxicity [22]. It does, however, require dose adjustment for patients with reduced kidney function. 

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