Renal impairment infusion rate adjustment

Heparin-induced thrombocytopenia and associated thromboembolic disease to prevent further thromboembolic complications IV, IV Infusion 0.2-0.4 mg/kg, IV slowly over 15-20 sec, followed by IV infusion of 0.1-0.15 mg/kg/hr for 2-10 days or longer. Dosaye in renal impairment Initial dose is decreased to 0.2 mg/kg, with infusion rate adjusted based on creatinine clearance. 

Should the patient manifest renal impairment for a drug eliminated by the kidneys, the infusion rate required to maintain the desired steady-state plasma concentration will be smaller and, please note, the elimination rate constant will also be smaller by an identical amount therefore, the ratio of infusion rate over elimination rate constant remains unaffected. This simply suggests, therefore, that it is vitally important to adjust (lower) the infusion rate of drug in a renally impaired subject. However, adjustment in the loading dose is neither necessary nor required. This statement can further be supported upon careful examination of Eq. 10.15, which clearly suggests that the... 

A loading dose of 0.2 mg/kg (repeated up to a maximum of 2 mg/kg) followed by a continuous infusion of 0.05 to 2 mg/kg per hour is recommended in RSE.29-31 The dose must be adjusted during prolonged infusions, especially in patients with renal impairment, as the active metabolite can accumulate.32 Breakthrough seizures are common with midazolam infusions and usually respond to a bolus and a 20% increase in the rate. Despite this, tachyphylaxis can occur and the patient should be switched to another agent if seizure activity continues. 

Special Precautions Exceeding recommended dosage and infusion rate could result in increased toxicity Dosage adjustment is required in presence of renal impairment Phlebitis and pain may occur at injection site... 

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