Precautions with renal impairment

In patients with renal impairment, take precautions when administering magnesium salicylate. 

Special Precaution Gastrointestinal hemorrhage may occur Patients with renal impairment have shown higher MPA and MPAG AUCs than normal volunteers Should not be used in conjunction with azathioprine Repeated laboratory monitoring is required Pregnancy Category C... 

PRECAUTIONS AND ADVERSE EFFECTS Patients with renal impairment should not receive metformin. Other contraindications include hepatic disease, a history of lactic acidosis, cardiac failure requiring drug therapy, or chronic hypoxic lung disease. These conditions all predispose to the potentially fatal complication of lactic acidosis. Metformin should be discontinued temporarily prior to the administration of intravenous contrast media and prior to any surgical procedure. The drug should not be readministered any sooner than 48 hours after such procedures and should be withheld until renal function is determined to be normal. 

Special Precautions Should be given with caution to patients with renal or hepatic impairment, folate deficiency, and severe allergy or asthma Pregnancy Category C ... 

Elderly patients may also be at a higher risk for adverse reactions because of their generally decreased organ fimctions and frequent use of multiple medications. The warnings and precautions of Crestor states that the risks for skeletal muscle effects increase with the use of 40 mg dose, advanced age ( ), hypothyroidism, renal impairment, and combination use with cyclosporine. 

Metaxalone should be prescribed with precaution in all patients with hepatic and/or renal impairment due to unknown impact of disease and dysfunction on the pharmacokinetics. 

Renai function impairment Use amphotericin B desoxycholate with care in patients with reduced renal function frequent monitoring is recommended (see Precautions). Lipid formulations have been reported to overcome most problems of chronic nephrotoxicity, even in patients with impaired renal function following previous treatment with amphotericin B desoxycholate. 

Monitoring Periodic monitoring for toxicity, including CBC with differential and platelet counts, and liver and renal function testing is mandatory. Periodic liver biopsies may be indicated in some situations. Monitor patients at increased risk for impaired methotrexate elimination (eg, renal dysfunction, pleural effusions, ascites) more frequently (see Precautions). 

Risk of opportunistic infections associated with decreased T-cell function for several months after treatment (PCP, mycobacterial infections) prophylactic antibiotics for PCP and HSV should be considered, particularly when fludarabine is used in combination with corticosteroids Rapid cell kill tumor lysis syndrome precautions needed reduce dose with impaired renal function... 

Radiopharmaceutical, to be prepared and administered only by personnel trained in radiopharmaceuticals premedicate with acetaminophen and antihistamines slow infusion rate or interrupt infusion for infusion reactions medications for treatment of hypersensitivity reactions should be available for immediate use avoid in pregnant females may cause hypothyroidism in fetus two-step administration MoAB and low radioisotope dose is followed after 1-2 weeks by MoAB and therapeutic radioisotope dose renally excreted impaired renal function may increase exposure to radioactive components patients must be trained in precautions to decrease radiation exposure to family, friends, and general public... 

Although venlafaxine is a weak inhibitor of CYP2D6, variability has been observed in the pharmacokinetic parameters of venlafaxine in patients with hepatic or renal function impairment. As a precaution, elderly patients taking venlafaxine concurrently with a drug that has a narrow therapeutic index and also is metabolized by CYP2D6 should be carefully monitored. Concurrent use of CYP3A4 inhibitors with venlafaxine has been shown to interfere with its metabolism and clearance. Similar to the other antidepressants that block 5-HT reuptake, venlafaxine may interact pharmacodynamically to cause toxic levels of 5-HT to accumulate, leading to the 5-HT syndrome. 

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