Renal clearance impaired

Kidney failure not only decreases renal clearance of nicotine and cotinine, but also metabolic clearance of nicotine (Molander et al. 2000). Metabolic clearance of nicotine is reduced by 50% in subjects with severe renal impairment compared to healthy subjects. It is speculated that accumulation of uremic toxins may inhibit CYP2A6 activity or downregulate CYP2A6 expression in liver. Hepatic metabolism of several drugs is reduced in kidney failure, mainly via downregulation of CYP enzymes and/or inhibition of transporters (Nolin et al. 2003). 

As mentioned previously, renal failure markedly reduces total renal clearance, as well as metabolic clearance of nicotine and cotinine (Molander et al. 2000). Reduction of renal clearance is correlated with the severity of kidney failure renal clearance is reduced by half in mild renal failure, and by 94% in severe renal impairment. Markedly elevated levels of serum nicotine have been detected in smoking patients with end-stage renal disease undergoing hemodialysis (Perry et al. 1984). This is explained not only by reduced renal clearance, but also by lower metabolic... 

Renal function impairment No changes were observed in the pharmacokinetics of dipyridamole or its glucuronide metabolite with creatinine clearances ranging from approximately 15 mL/min to more than 100 mL/min if data were corrected for differences in age. Avoid aspirin in patients with severe renal failure (glomerular filtration rate less than 10 mL/min). 

Renal function impairment W th renal impairment, relative overdose might occur even with a standard dosage regimen. In patients with marked renal insufficiency (creatinine clearance less than 15 mL/min) and on hemodialysis, elimination half-lives are prolonged 2 days or less. Reduce the bolus dose and rate of infusion in patients with known or suspected renal insufficiency (see Administration and Dosage). 

Renal function Impairment Drug elimination was related to GFR. Clearance was reduced approximately 20% in patients with moderate and severe renal impairment and was reduced approximately 80% in dialysis-dependent patients. 

Renal function impairment Patients with type 2 diabetes who have severe renal function impairment should initiate repaglinide with the 0.5 mg dose. Studies were not conducted in patients with creatinine clearances lower than 20 mL/min or patients with renal failure requiring hemodialysis. 

Renal function impairment There was a statistically significant 27% decrease in plasma clearance of nalmefene in the end-stage renal disease (ESRD) population during interdialysis (0.57 L/h/kg) and a 25% decreased plasma clearance in the ESRD population during intradialysis (0.59 L/h/kg) compared with controls (0.79 L/h/kg). The elimination half-life was prolonged in ESRD patients from 10.2 (controls) to 26.1 hours. 

Renal function impairment- In patients with renal impairment, clearance of betaxolol declines with decreasing renal function. 

Renal function impairment No correlation was observed between plasma clearance of epierenone and creatinine clearance. Epierenone is not removed by hemodialysis. Hepatic function impairment In 16 subjects with mild to moderate hepatic impairment who received 400 mg of epierenone, no elevations of serum potassium above 5.5 mEq/L were observed. The mean increase in serum potassium was 0.12 mEq/L in patients with hepatic impairment and 0.13 mEq/L in normal controls. The use of epierenone in patients with severe hepatic impairment has not been evaluated. 

Renal function impairment In volunteers with severe renal impairment (Ccr 30 mL/min or less), sildenafil clearance was reduced. Consider an initial sildenafil dose of 25 mg in these patients. There is no clinical data on the safety or efficacy of vardenafil in patients with end-stage renal disease requiring dialysis. 

Renal function impairment- For patients with severe renal impairment (creatinine clearance [Ccr] less than 30 mL/min), the recommended dose is 20 mg once daily at bedtime. 

Renal function impairment - In patients with a creatinine clearance less than 30 mL/min, increase the dosing interval to 12 hours, with a maximum daily dose of 200 mg. Because hemodialysis only removes 7% of an administered dose, dialysis patients can receive their regular dose on the day of dialysis. 

Renal function impairment Use rizatriptan and sumatriptan with caution in dialysis patients because of a decrease in the clearance. 

Renal function impairment T zan 6 r e should be used with caution in patients with renal insufficiency (creatinine clearance less than 25 mL/min), as clearance is reduced by greater than 50%. 

Renal function impairment Because these agents are excreted primarily via the kidneys, decreased clearance may occur reduced dosage may be necessary. P.806... 

Renal function impairment- Ceftibuten may be given at normal doses in impaired renal function with creatinine clearance of at least 50 mL/min. Dosing recommendations for patients with varying degrees of renal insufficiency are presented in the following table. 

Renal function impairment Plasma clearance of meropenem correlates with Ccr. In moderate renal dysfunction (Ccr 30 to 80 mL/min), mean half-life has been prolonged to 1.93 to 3.36 hours. In patients with greater dysfunction (Ccr 2 to 30 mg/min), mean half-life has been further prolonged to 3.82 to 5.73 hours. Patients undergoing hemodialysis (patients with end-stage renal disease) had mean... 

Renal function impairment WnWe caution should be used in patients with severe renal failure, therapeutic concentrations of nalidixic acid in the urine, without increased toxicity caused by drug accumulation in the blood, have been observed in patients on full dosage with creatinine clearances (Ccr) as low as 2 to 8 mL/min. Special risk Use nalidixic acid with caution in patients with epilepsy, liver disease, or severe cerebral arteriosclerosis. 

Renal function impairment A pharmacokinetic study in subjects with renal failure undergoing hemodialysis showed that voriconazole is dialyzed with clearance of 121 mL/min. The IV vehicle, SBECD, is hemodialyzed with clearance of 55 mL/min. A 4-hour hemodialysis session does not remove a sufficient amount of voriconazole to warrant dose adjustment. 

Renal function impairment Use ganciclovir with caution. Half-life and plasma/serum concentrations of ganciclovir will be increased because of reduced renal clearance (see Administration and Dosage). 

Renal function impairment Ad usi the dosing interval of tenofovir in patients with baseline creatinine clearance (Ccr) less than 50 mL/min using the recommendations in the following table. The safety and effectiveness of these dosing interval recommendations have not been clinically evaluated closely monitor clinical response to treatment and renal function in these patients. 

Renal function impairment Relatively oliguric patients, especially those with tubular necrosis in the immediate postcadaveric transplant period, may have delayed clearance of azathioprine or its metabolites. 

Renal function impairment- In patients with end-stage renal disease requiring hemodialysis, dose reduction to 135 meg peginterferon alfa-2a is recommended. Closely monitor for signs and symptoms of interferon toxicity. Do not use ribavirin in patients with creatinine clearance less than 50 mL/min. 

Renal function impairment The mean plasma clearance decreased 70% to 75% in normal subjects with severe or end-stage renal disease (Ccr less than 30 mL/min). 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

The most common adverse effects of lamivudine seen at doses used to treat HBV are mild they include headache, malaise, fatigue, fever, insomnia, diarrhea, and upper respiratory infections. Elevated alanine aminotransferase (ALT), serum lipase, and creatine kinase may also occur. The safety and efficacy of lamivudine in patients with decompensated liver disease have not been established. Dosage adjustment is required in individuals with renal impairment. Coadministration of trimethoprim-sulfamethoxazole decreases the renal clearance of lamivudine. 

Dosage in renal function impairment Based on creatinine clearance ... 

Geriatric Considerations-Summary Minimal renal clearance and metabolized to inactive metabolites, therefore may be safer in older adults with impaired renal func-... 

Procainamide is eliminated by hepatic metabolism to NAPA and by renal elimination. Its half-life is only 3-4 hours, which necessitates frequent dosing or use of a slow-release formulation (the usual practice). NAPA is eliminated by the kidneys. Thus, procainamide dosage must be reduced in patients with renal failure. The reduced volume of distribution and renal clearance associated with heart failure also require reduction in dosage. The half-life of NAPA is considerably longer than that of procainamide, and it therefore accumulates more slowly. Thus, it is important to measure plasma levels of both procainamide and NAPA, especially in patients with circulatory or renal impairment. 

Digoxin is not extensively metabolized in humans almost two thirds is excreted unchanged by the kidneys. Its renal clearance is proportional to creatinine clearance and the half-life is 36-40 hours in patients with normal renal function. Equations and nomograms are available for adjusting digoxin dosage in patients with renal impairment. 

Proton pump inhibitors undergo rapid first-pass and systemic hepatic metabolism and have negligible renal clearance. Dose reduction is not needed for patients with renal insufficiency or mild to moderate liver disease but should be considered in patients with severe liver impairment. Although other proton pumps exist in the body, the H+,K+ ATPase appears to exist only in the parietal cell and is distinct structurally and functionally from other H+ -transporting enzymes. 

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