Renal impairment oral dosing

Clarithromycin is a macrolide antibacterial agent that should be used with caution in patients with renal impairment. The dose should be reduced if creatinine clearance is less than 30 mL/minute and the modified-release oral preparation should be avoided in this scenario. 

The therapeutic dose of acamprosate is 666 mg orally three times daily, and it is supplied as a 333 mg tablet. It can be started at the full dose in most patients without titration. It differs from disulfiram and naltrexone in that it is excreted by the kidneys without liver metabolism. Consequently, it is contraindicated in patients with severe renal impairment (creatinine clearance less than or equal to 30 mL/minute), and dose reduction is necessary when the creatinine clearance is between 30 and 50 mL/minute. The most common side effects are gastrointestinal and include nausea and diarrhea. Rates of suicidal thoughts were also increased in patients treated for 1 year with acamprosate (2.4%) versus placebo (0.8%). If necessary the total daily dose maybe decreased by 1 to 3 tablets (333-999 mg) per day to alleviate side effects. 

Systemic corticosteroids are a useful option in patients with contraindications to NSAIDs or colchicine (primarily renal impairment) or polyarticular attacks, especially in elderly patients. A single intramuscular injection of a long-acting corticosteroid such as triamcinolone hexacetonide may be used. Oral agents may be needed, especially for severe attacks. Prednisone 40 to 60 mg (or an equivalent dose of another agent) is given daily, with a gradual taper over 2 weeks. 

Oral allopurinol (Zyloprim ) Adult 600-800 mg/day in 2-3 divided doses Child 10 mg/kg per day or 200-300 mg/m2 per day Adult 200-400 mg/m2 per day Child 200 mg/m2 per day 0.48/day (generic) Adjust dose for renal impairment. Avoid drug interactions (mercaptopurine). Monitor for skin rash. 

Sitagliptin (Januvia) is usually dosed at 100 mg orally once daily. In patients with renal impairment, the daily dose should be reduced to 50 mg (creatinine clearance 30-50 mL/min) or 25 mg (creatinine clearance <30 mL/min). 

Renal impairment (Ccriess than 50 mUmin)- 150 mg orally every 24 hours or 50 mg parenterally every 18 to 24 hours. The frequency of dosing may be increased to every 12 hours or further with caution. 

Ofloxacin - Maximum serum concentrations are achieved 1 to 2 hours after an oral dose. Steady-state concentrations are achieved after 4 doses. Ofloxacin is widely distributed to body tissues and fluids. Elimination is mainly by renal excretion 4% to 8% is excreted in the feces. A longer plasma half-life of about 6.4 to 7.4 hours was observed in elderly subjects, compared with 4 to 5 hours for young subjects. Dosage adjustment is necessary for patients with impaired renal function (Ccr 50 mL/min or less). 

Systemic absorption Clinically significant serum concentrations may occur in some patients who have taken multiple oral doses for active C. c//fif/c/7e-induced pseudomembranous colitis or who have inflammatory disorders of the intestinal mucosa the risk is greater with the presence of renal impairment. 

Oral In renal impairment, modify the dose of oral ganciclovir as follows ... 

Reduction of dose Dose reductions are required with IV therapy and should be considered with oral therapy for patients with renal impairment and for those with neutropenia, anemia, or thrombocytopenia. Do not administer in severe neutropenia (ANC less than 500/mcL) or severe thrombocytopenia (platelets less than 25,000/mcL). 

Hepatic/Renal function impairment Because of the potential for nephrotoxicity, give patients with renal or hepatic impairment doses at the lowest value of the recommended IV and oral dosing ranges. Therapy may need to be delayed by up to 48 hours or longer in patients with postoperative oliguria. 

Uses Severe, systemic fungal Infxns oral cutaneous candidiasis Action Binds ergosterol in the fungal membrane to alter permeability Dose Adults Peds. Test dose 1 mg IV adults or 0.1 mg/kg to 1 mg IV in children then 0.25-1.5 mg/kg/24 h IV over 2-6 h (range 25-50 mg/d or qod). Total dose varies w/ indication PO 1 mL qid Caution [B, ] Disp Inj SE -1- K /Mg from renal wasting anaphylaxis reported, HA, fever, chills, n hrotox, -1- BP, anemia, rigors Notes -1- In renal impair pre-Tx w/ APAP antihistamines (Benadryl) X SE Interactions T Nephrotoxic effects W/ antineoplastics, cyclosporine, furosemide, vancomycin, aminoglycosides, T hypokalemia W/ corticost oids, skeletal muscle relaxants EMS May cause electrolyte imbalances, monitor ECG OD May effect CV and resp Fxn symptomatic and supportive... 

Minocycline (Solodyn) [Antibiotic/Tetracycline] Uses Acne Action Tetracycline, bactmostatic Dose Adults Peds >12 y. 1 mg/kg PO daily X 12wk w/ food to -1- irritation Caution [C, ] assoc w/ pseudomembranous colitis w/ renal impair Contra AU gy, women of childbearing potential Disp Tabs SE D, HA, fevCT, rash, joint pain, fatigue, dizziness Interactions t Effects OF digoxin, oral anticoagulants t risk of n hrotox W/ methoxyflurane X effects W/... 

Orally administered thiazides are rapidly absorbed from the gastrointestinal tract and begin to produce diuresis in about 1 hour. Approximately 50% of an oral dose is excreted in the urine within 6 hours. These compounds are organic acids and are actively secreted into the proximal tubular fluid by the organic acid secretory mechanism. There also appears to be an extrarenal pathway for their elimination involving the hepatic-biliary acid secretory system that is particularly important for thiazide elimination when renal function is impaired. 

Acyclovir absorption is variable and incomplete following oral administration. It is about 20% bound to plasma protein and is widely distributed throughout body tissues. Significant amounts may be found in am-niotic fluid, placenta, and breast mUk. Acyclovir is both filtered at the glomeruU and actively secreted. Most of the dose is excreted in the urine as unchanged drug a small portion is excreted as an oxidized inactive metabolite. The plasma half-Ufe of acyclovir is 3 to 4 hours in patients with normal kidney function and up to 20 hours in patients with renal impairment. 

Other CMV infections IV Initially, 10mg/kg/dayindivideddosesql2hfor 14-21 days, then 5 mg/kg/day as a single daily dose. Maintenance 1000 mg 3 times a day or 500 mg q3h (6 times a day). Intravitreal implant 1 implant q6-9mo plus oral ganciclovir. Dosage in renal impairment Dosage and frequency are modified based on creatinine clearance. 

In the USA, disopyramide is only available for oral use. The typical oral dosage of disopyramide is 150 mg three times a day, but up to 1 g/d has been used. In patients with renal impairment, dosage must be reduced. Because of the danger of precipitating heart failure, loading doses are not recommended. 

Flucytosine is currently available in North America only in an oral formulation. The dosage is 100-150 mg/kg/d in patients with normal renal function. It is well absorbed (> 90%), with serum concentrations peaking 1-2 hours after an oral dose. It is poorly protein-bound and penetrates well into all body fluid compartments, including the cerebrospinal fluid. It is eliminated by glomerular filtration with a half-life of 3-4 hours and is removed by hemodialysis. Levels rise rapidly with renal impairment and can lead to toxicity. Toxicity is more likely to occur in AIDS patients and those with renal insufficiency. Peak serum concentrations should be measured periodically in patients with renal insufficiency and maintained between 50 and 100 mcg/mL. 

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