THE APhA COMPLETE REVIEW FOR PHARMACY, 7th Ed

Appendix B: Drugs in Renal Failure

       

Dose adjustment for renal failure

 

Generic name

Trade name

Dose for normal renal function

CrCl > 50 mL/min

CrCl = 10-50 mL/min

CrCl < 10 mL/min

Supplement for hemodialysis

Analgesics

           

Acetaminophen

FeverAll, Genapap, Tylenol

650 mg po q4h

q4h

q6h

q8h

None

Aspirin

Ascriptin, Aspergum, Aspirtab, Bayer, Easprin, Ecotrin, Ecpirin, Entercote

650 mg po q4h

q4h

q4-6h

Avoid

Dose after dialysis

Butorphanol

 

2 mg q3-4h

Same

75% of normal dose

50% of normal dose

No data

Codeine

 

30-60 mg po q4-6h

Same

75% of normal dose

50% of normal dose

No data

Fentanyl

Sublimaze

Anesthetic induction (individualized)

Same

75% of normal dose

50% of normal dose

Not applicable

Hydromorphone

Dilaudid

1-2 mg IV q4-6h

Same

Same

Same

Same

Meperidine

Demerol

50-100 mg IV or po q3-4h

Same

37.5-75 mg IV or po q3-4h

25-50 mg IV or po q3-4h

Avoid

Methadone

 

2.5-10 mg q6-8h

Same

Same

50-75% of normal dose

Same

Morphine

 

20-25 mg po q4h

Same

15-18.75 mg po q4h

10-12.5 mg po q4h

Same

Pentazocine

 

50 mg q4h

Same

75% of normal dose

50% of normal dose

Same

Propoxyphene

Darvon

65 mg po q6-8h

Same

Same

Avoid

Avoid

Antiarrhythmics

           

N-acetyl-procainamide

 

500 mg q6-8h

Same

50% q8-12h

25% q12-18h

Same

Adenosine

Adenocard

3-6 mg IV bolus

Same

Same

Same

Same

Atropine

 

0.5-1 mg IV push q3-5 min, max 0.04 mg/kg

Same

Same

Same

Same

Class I

           
 

Moricizine

Ethmozine

200-300 mg po q8h

Same

Same

Same

Same

 

Propafenone

Rythmol

150-300 mg po q8h

Same

Same

Same

Same

Class Ia

           
 

Disopyramide

Norpace

100-200 mg q6h

100-200 mg q8h

100-200 mg q12-24h

100-200 mg q24-48h

Same

 

Procainamide

Procan, Pronestyl

1,000-2,500 mg q12h

1,000-2,500 mg q4h

1,000-2,500 mg q6-12h

1,000-2,500 mg q8-24h

Maintenance dose post-HD

 

Quinidine

Quinidex, Quinaglute

300-600 mg po q8-12h

Same

Same

150-300 mg po q4-6h

Dose post-HD

Class Ib

           
 

Lidocaine

Xylocaine

50-100 mg IV over 1-2 min bolus, then 1-4 mg/min IV

Same

Same

Same

Same

 

Mexiletine

Mexitil

200-400 mg po q8-12h

Same

Same

Same

Same

 

Tocainide

Tonocard

400-600 mg po q8h

Same

Same

Same

Dose post-HD

Class Ic

           
 

Encainide

Enkaid

25-50 mg po q8-12h

25-50 mg po q12-24h

25 mg po q24h

25 mg po q24h

Same

 

Flecainide

Tambocor

50-100 mg po q12h

Same

25-50 mg po q12h

25-50 mg po q12h

Same

Class II (see β-blockers in antihypertensives)

           

Class III

           
 

Amiodarone

Cordarone

800-2,000 mg load, then 200-600 mg q24h

Same

Same

Same

Same

 

Bretylium

Bretyol

5-30mg/kg load, then 5-10 mg IV q6h

Same

25-50% of normal dose

25% of normal dose

Same

Class IV (see calcium channel blockers in antihypertensives)

           

Antibiotics

           

Aminoglycosides

           
 

Amikacin

Amikin

7.5 mg/kg IV q12h

60-90% of normal dose q12h

30-70% of normal dose q12-18h

20-30% of normal dose q24-48h

50% of full dose post-HD

 

Gentamicin

Garamycin

1.7 mg/kg q8h

1.7 mg/kg q8-24h

1.7 mg/kg q12-48h by levels

1.7 mg/kg IV q48-72h by levels

50% of full dose post-HD

 

Tobramycin

Nebcin

1.7 mg/kg q8h

1.7 mg/kg q8-24h

1.7 mg/kg q24-48h by levels

1.7 mg/kg IV q48-72h by levels

50% of full dose post-HD

Cephalosporins

           
 

Cefaclor

Ceclor

250-500 mg po q8h

Same

Same

Same

250-500 mg po post-HD

 

Cefadroxil

Duricef

0.5-1 g po q12h

500 mg po q12h

500 mg po q12-24h

500 mg po q24-48h

0.5-1 g po post-HD

 

Cefazolin

Ancef, Kexol

0.25-2g q6h

0.25-2g q8h

0.25-2g q12h

50% of normal dose q24-48h

15-20 mg/kg post-HD

 

Cefepime

Maxipime

250-2,000 mg q8-12h

Same

125-2,000 mg q24h

25-50% of normal dose q24h

25-50% of normal dose q24h post-HD

 

Cefixime

Suprax

200 mg po q12h

150-200 mg po q12h

150 mg po q12h

100 mg po q12h

300 mg po post-HD

 

Cefotaxime

Claforan

1-2 g IV q6-12h

Same

1-2 g IV q8-12h

1-2 g IV q24h

0.5-2 g IV q24h post-HD

 

Cefotetan

Cefotan

1-2 g IV q12h

Same

50% of normal dose

25% of normal dose

1g post-HD

 

Cefoxitin

Mefoxin

1-2 g IV q6-8h

1-2 g IV q8h

1-2 g IV q8-12h

1-2 g IV q24-48h

1g post-HD

 

Cefpodoxime

Vantin

100-400 mg q12h

Same

Same

100-400 mg q24h

Dose post-HD

 

Cefprozil

Cefzil

250-500 mg po q12h

Same

50% q12h

50% q12h

250 mg po post-HD

 

Ceftazidime

Ceptaz, Fortaz, Tazicef, Tazidime

1 g IV q8-12h

1 g IV q12h

0.5-1 g IV q12-24h

500 mg q24-48h

1g post-HD

 

Ceftizoxime

Cefizox

1-2 g IV q8h

0.5-1.5 g q8h

0.25-1 g q12h

0.5-1 g q24-48h

1 g post-HD

 

Ceftriaxone

Rocephin

0.25-2 g IV q12-24h

Same

Same

Same

Same

 

Cefuroxime

Ceftin, Kefurox, Zinacef

250-500 mg q12h

Same

Same

Same

Dose post-HD

 

Cephalexin

Keflex

250-500 mg po q6h

250-500 mg po q6-8h

250-500 mg po q12h

250-500 mg po q12h

Dose post-HD

Fluoroquinolones

           
 

Ciprofloxacin

Cipro

500-750 mg po q12h; 400 mg IV q12h

Same

250-500 mg po q18h; 400 mg IV q24h

250-500 mg po q18h; 400 mg IV q24h

250 mg q12h (200 mg if IV)

 

Gatifloxacin

Tequin

400 mg po or IV q24h

Same

400 mg po or IV × 1, then 200 mg po or IV q24h

400 mg IV or po × 1, then 200 mg po or IV q24h

400 mg po or IV × 1, then 200 mg po or IV q24h post-HD

 

Levofloxacin

Levaquin

250-500 mg po or IV q24h

Same

500 mg po or IV × 1, then 250 mg po or IV q48h

500 mg po or IV × 1, then 250 mg po or IV q48h

500 mg po or IV × 1, then 250 mg po or IV q48h post-HD

Miscellaneous

           
 

Aztreonam

Azactam

500 mg-2 g q8-12h

Same

250 mg-1 g q8-12h

125-500 mg q8-12h

1-2 g IV loading dose, then 0.5 g IV q6-8h post-HD

 

Erythromycin

E-Mycin

250-500 mg po q6h

Same

Same

Same

Same

 

Imipenem

Primaxin

0.25-1 g IV q6h

Same

500 mg IV q12h

250 mg IV q12h

250 mg IV q12h post-HD

 

Linezolid

Zyvox

600 mg IV q12h

Same

Same

Same

Dose post-HD

 

Meropenem

Merrem

1-2 g IV q8h

Same

50-100% normal dose q12h

50% normal dose q24h

500 mg IV q24h post-HD

 

Quinupristin-dalfopristin

Synercid

7.5 mg/kg IV q8h

Same

Same

Same

Same

 

Rifampin

Rifadin

600 mg po q24h

Same

300-600 mg po q24-48h

300-600 mg po q48h

Same

 

Trimethoprim-sulfamethoxazole

Bactrim, Septra

8-20 mg/kg/d po q6-12h or IV q12h

Same

4-10 mg/kg/d po or IV q12h

Avoid

2-5 mg/kg/d po or IV q24h post-HD

 

Vancomycin

Vancocin

500 mg IV q6h or 1 g q12h

1 g IV q12-24h

1 g IV q24-96h

1 g IV q4-7d

1 g IV q4-7d

Penicillins

           
 

Amoxicillin-clavulanic acid

Augmentin

250-500 mg po q8h; 875 mg po bid

Same

250-500 mg po q12h

250-500 mg po q24h

250-500 mg po q24h; supplemental dose during and at the end of dialysis

 

Ampicillin

Principen, Omnipen

250-500 mg q6h

250-500 mg q6h

250-500 mg q6-12h

250-500 mg q12-24h

dose post-HD

 

Ampicillin-sulbactam

Unasyn

1.5-3 g q6h

1.5-3 g q8h

1.5-3 g q12h

1.5-3 g q24h

dose post-HD

 

Methicillin

Staphcillin

1-2 g IV q4-6h

Same

1-2 g IV q6-8h

1-2 g IV q8-12h

Same

 

Nafcillin

Nafcin, Unipen

1-2 g IV q4-6h

Same

Same

Same

Same

 

Oxacillin

Bactocil

1-2 g IV q4-6h

Same

Same

Same

Same

 

Penicillin G

 

1-4 million units IV q4-6h

1-4 million units IV q6-8h

1-4 million units IV q8-12h

1-4 million units IV q12-18h

1-4 million units IV q12-18h

 

Piperacillin

Pipracil

3-4 g IV q6h

Same

3-4 g IV q6-8h

3-4 g IV q8h

2 g IV q8h plus 1 g post-HD

 

Piperacillin-tazobactam

Zosyn

3.375-4.5 g IV q6-8h

3.375 g

2.25 g IV q6h (q8h if CrCl < 20 mL/min)

2.25 g q8h

2.25 g IV q8h post-HD

 

Ticarcillin

Ticar

3 g IV q4h

1-2 g IV q4-8h

1-2 g IV 8h

1-2 g IV q12h

2 g IV q12h; 3 g supplement post-HD

 

Ticarcillin-clavulanic acid

Timentin

3.1 g IV q4h

2 g IV q4h or 3.1 g IV q4-8h

2 g IV q4-8h

2 g IV q12h

2 g IV q12h post-HD

Anticoagulants

           

Enoxaparin

Lovenox

30 mg SC q12h

Same

30 mg SC qd

30 mg SC qd

Limited data

     

40 mg SC qd

Same

30 mg SC qd

30 mg SC qd

 
     

1 mg/kg SC q12h

Same

1 mg/kg SC qd

1 mg/kg SC qd

 

Anticonvulsants

           

Carbamazepine

Tegretol

200 mg po bid; second dose: 1,200 mg po q24h

Same

Same

75% of normal dose

75% of normal dose

Diazepam

Valium

2-10 mg po q6-24h

Same

Same

Same

Same

Ethosuximide

Zarontin

500-1,500 mg po q24h

Same

Same

75% of normal dose

Same

Gabapentin

Neurontin

300-600 mg po tid

400 mg po tid

300 mg po q12-24h

300 mg po qod

300 mg load, then 200-300 mg post-HD

Lamotrigine

Lamictal

50 mg po q12-24h initially, then 100-500 mg po q24h

Same

75% of normal dose

100 mg qod

100 mg postdialysis

Lorazepam

Ativan

1-2 mg q8-12h

Same

Same

Same

Same

Oxcarbazepine

Trileptal

300-600 mg bid

Same

75-100% of normal dose

50% of normal dose

50% of normal dose post-HD

Phenobarbital

Luminal, Solfoton

50-100 mg q8-12h

Same

Same

50-100 mg q12-16h

Dosage supplementation is required post-HD

Phenytoin

Dilantin

100 mg tid

Same

Same

Same

Same

Primidone

Mysoline

250 mg tid or qid

250 mg q8h

250 mg q8-12h

250 mg q12-24h

30% of normal dose post-HD

Sodium valproate

Depakene, Depakote

15-60 mg/kg q24h

Same

Same

Same

No dose adjustment necessary

Topiramate

Topamax

200 mg po q12h

Same

50% of normal dose

25% of normal dose

Same

Antiemetics

           

Metoclopramide

Reglan

10-15 mg IV qid

Same

7.5-15 mg IV q6h

5-7.5 mg IV q6h

Same

Antifungals

           

Amphotericin B nonlipid

Fungizone

0.25-1 mg/kg IV q24h

Same

Same

0.25-1 mg/kg IV q24-36h

Same

Amphotericin B lipid complex

Abelcet

5 mg/kg IV q24h

Consider dosage adjustment; specific guidelines not available

Consider dosage adjustment; specific guidelines not available

Consider dosage adjustment; specific guidelines not available

Supplemental dose is not necessary

Amphotericin B cholesteryl sulfate complex

Amphotec

3-6 mg/kg/d IV q24h

Same

Same

3-6 mg/kg/d IV q48h

3-6 mg/kg/d IV q48h

Amphotericin B liposome

AmBisome

3-5 mg/kg IV q24h

Same

Same

3-5 mg/kg IV q48h

3-5 mg/kg IV q48h

Fluconazole

Diflucan

100-400 mg po or IV q24h

Same

50-200 mg po or IV q24h

50-200 mg po or IV q24h

Same

Itraconazole

Sponanox

100-200 mg po or IV q12h

Same

Same

100-200 mg po q24h (IV contraindicated)

100 mg po q12-24h (oral only)

Ketoconazole

Nizoral

200-400 mg po q24h

Same

Same

Same

Same

Antihistamines

           

Cimetidine

Tagamet

400 mg po bid or 400-800 mg qhs

Same

200 mg po bid

300 mg q8-12h

Dose post-HD

Famotidine

Pepcid

20-40 mg po qhs

5-20 mg po qhs

2-10 mg po qhs

2-4 mg po qhs

Supplemental doses are not required post-HD

Nizatidine

Axid

150 mg po q12h or 300 mg po qhs

150 mg po q24h

150 mg po q24-48h

150 mg po q48-72h

150 mg po q48h

Ranitidine

Zantac

150-300 mg po qhs; 50 mg IV q6h; 6.25 mg/h continuous infusion

75-150 mg po qhs; 50 mg IV q12h

150 mg po q12-24h; 50 mg IV q18-24h

75-150 mg po q24h; 50 mg IV q24h

50% of po dose post-HD; 50 mg IV q24h post-HD

Antihypertensives

           

Angiotensin-converting enzyme (ACE) inhibitors

           
 

Benazepril

Lotensin

10-40 mg po q12-24h

10-40 mg po q24h

5-20 mg po q24h

5-20 mg po q24h

5-20 mg po q24h

 

Captopril

Capoten

25-150 mg po q8h

25-150 mg po q8-12h

18.75-75 mg po q12-18h

12.5-50 mg po q24h

Administer dose post-HD or administer 25-35% supplemental dose

 

Enalapril

Vasotec

5-10 mg po q12h

5 mg po qd titrated upwards to maximum of 40 mg

2.5-10 mg po q12h

2.5-5 mg po q12h

2.5-7.5 po q12h

 

Enalaprilat

Vasotec

1.25-5 mg IV q6h

1.25-2.5 mg IV q6h

0.625 mg IV × 1, then up to 1.25 mg q6h if response is inadequate

0.625 mg IV × 1, then up to 1.25 mg q6h if response is inadequate

0.625 mg IV q6h

 

Fosinopril

Monopril

10-40 mg po q12-24h

10-40 mg po q24h

10-40 mg po q24h

7.5-30 mg po q24h

Same

 

Lisinopril

Zestril

10-40 mg po q24h

Same

2.5-7.5 mg po q24h

1.25-2.5 mg po q24h

2.5 mg initially, then 20% of patient's dose post-HD if patient is on a dosing regimen

 

Quinapril

Accupril

10-80 mg po q24h

10 mg po qd initially

7.5-60 mg po q24h

7.5-60 mg po q24h

2.5 mg initially, then 25% of patient's dose post-HD if patient is on a dosing regimen

 

Ramipril

Altace

2.5-20 mg po q24h

Same

1.25-15 mg po q24h

1.25-10 mg po q24h

Supplement 20% of patient's dose post-HD

α-blockers

           
 

Doxazosin

Cardura

1-16 mg po q24h

Same

Same

Same

Same

 

Prazosin

Minipress

1-15 mg po q12h

Same

Same

Same

Same

 

Terazosin

Hytrin

1-20 mg po q24h

Same

Same

Same

Same

Angiotensin-receptor blockers

           
 

Candesartan

Atacand

8-32 mg po q24h

Same

Same

Same

Same

 

Irbesartan

Avapro

150-300 mg po q24h

Same

Same

Same

75 mg initial dose

 

Losartan

Cozaar

25-100 mg po q12-24h

Same

Same

Same

Same

 

Valsartan

Diovan

80-320 mg po q24h

Same

Same

Same

Same

β-blockers

           
 

Atenolol

Ternormin

50-100 mg po q24h

Same

25-50 mg po q24h

25 mg po q96h

Administer dose post-HD or administer 25-50 mg supplemental dose

 

Carvedilol

Coreg

6.25-50 mg po q12h

Same

Same

Same

Same

 

Labetalol

Normodyne

200-400 mg po bid

Same

Same

Same

Same

 

Metoprolol

Lopressor

50-400 mg po q24h

Same

Same

Same

Supplement 50 mg po post-HD

 

Nadolol

Corgard

40-320 mg/d po single or divided doses

40-320 mg/d po q24h

40-320 mg/d po q24-48h

40-320 mg/d po q40-60h

Supplemental dose post-HD

 

Pindolol

Visken

10-40 mg po q12h

Same

Same

Same

Same

 

Propranolol

Inderal

80-160 mg po bid

Same

Same

Same

Same

 

Sotalol

Betapace

80-160 mg po q12h

80-160 mg po q12-24h

80-160 mg po q24-48h

80-160 mg po q4-72h

Same; supplement 80 mg post-HD

Calcium channel blockers

           
 

Amlodipine

Norvasc

2.5-10 mg po q24h

Same

Same

Same

Same

 

Diltiazem

Dilacor, Cardizem, Tiazac

180-480 mg po q24h

Same

Same

Same

Same

 

Felodipine

Plendil

2.5-10 mg po q24h

Same

Same

Same

Same

 

Isradipine

Dynacirc

2.5-5 mg po q12-24h

Same

Same

Same

Same

 

Nicardipine

Cardene

20-40 mg po tid

Same

Same

Same

Same

 

Nifedipine

Adalat, Procardia

10-30 mg/d po tid

Same

Same

Same

Same

 

Nimodipine

Nimotop

30 mg po q8h

Same

Same

Same

Same

 

Verapamil

Calan, Isoptin, Verelan

80-120 mg po q8h

Same

Same

Same

Same

Diuretics

           
 

Bumetanide

Bumex

1-2 mg IV q8-12h

Same

Same

Same

Same

 

Furosemide

Lasix

40-80 mg IV q12h

Same

Same

Same

Same

 

Hydrochlorothiazide

Hydrodiuril

25-200 mg po qd tid

Same

Same

Not effective

Not applicable

 

Spironolactone

Aldactone

25 mg tid-qid

25 mg q6-12h

25 mg q12-24h

Avoid

Not applicable

 

Triamterene

Dyrenium

25-150 mg q12-24h

25-150 mg q12h

Avoid

Avoid

Not applicable

Antivirals

           

Acyclovir

Zovirax

5-10 mg/kg po or IV q8h

Same

5-10 mg/kg po or IV q12-24h

2.5-5 mg/kg po or IV q24h

2.5-5 mg/kg po or IV q24h post-HD

Amantadine

Symmetrel

100 mg po q12h

Same

100 mg po q24-48h

200 mg po q7d

200 mg po q7d

Didanosine

Videx

200 mg po q12h; second dose: 250-400 mg q24h

200 mg po q12h

200 mg po q24h

100 mg po q24h

Dose per CrCl < 10 mL/min; no supplemental dosing necessary

Entecavir

Baraclude

0.5-1 mg po qd

0.25-0.5 mg qd

0.15-0.3 mg qd

0.05-0.1 mg qd

Dose post-HD: 0.05 mg po qd for treatment-naive patients and 0.1 mg po qd for lamivudine-refractory patients

Famciclovir

Famvir

125 mg po q12h or 500 mg po q8h

500 mg q8-12h

125 mg po q12-24h or 500 mg po 12-24h

62.5 mg po q24h or 250 mg po q24h

250 mg following each dialysis session

Ganciclovir

Cytovene

5 mg/kg IV q12h

2.5-5 mg/kg q12h

1.25-2.5 mg/kg q24h

1.25 mg/kg 3 times/week

1.25 mg/kg 3 times/week post-HD

Indinavir

Crixan

800 mg po q8h

No data: same

No data: same

No data: same

No adjustment necessary

Lamivudine

Epivir

150-300 mg po q12-24h

100-300 mg po qd

50-150 mg po q24h

25-50 mg po q24h

Supplemental dosing is not required

Nelfinavir

Viracept

750 mg po q8h; second dose: 1,250 mg bid

Same

Same

Same

Same

Nevirapine

Viramune

200 mg po q24h × 14 d, then q12h

Same

Same

Same

An additional 200 mg dose is recommended following dialysis

Ribavirin

Rebetol

1,000-1,200 mg q24h

Same

Avoid

Avoid

Additional dose recommended after each dialysis session in HIV patients with CrCl < 10 mL/min

Ritonavir

Norvir

600 mg po q12h

Same

Same

Same

Same

Saquinavir

Fortovase, Invirase

600-1,200 mg po q8h

Same

Same

Same

Same

Stavudine

Zerit

30-40 mg po q12h

Same

15-20 mg po q12-24h

15-20 mg po q24h

15-20 mg po q24h

Valacyclovir

Valtrex

500 mg po q12h to 1,000 mg po q8h

Same

500-1,000 mg po q12-24h

500 mg q24h

Dose post-HD

Zalcitabine

Hivid

0.75 mg po q8h

Same

0.75 mg po q12h

0.75 mg po q24h

No data

Zidovudine

Retrovir

200 mg po q8h; second dose: 300 mg po q12h

Same

Same

100 mg po q8h

100 mg po q8h

Bisphosphonates

           

Zoledronic acid

Zometa

4 mg IV

3.5 mg IV

3-3.3 mg IV

Avoid

No data

Gout agents

           

Allopurinol

Zyloprim

300 mg po q24h

150-200 mg po q24h

150 mg po q24h

100 mg po q48h

150 mg supplemental dose

Colchicine

Acetycol, Colsalide

Acute: 2 mg, then 0.5 mg po q6h; chronic: 0.5-1 mg po q24h

Same

Decrease normal dose by 50% to no change

Decrease normal dose by 25%

Same

Probenecid

Benemid

500 mg po bid

Not effective

Not effective

Not effective

Not effective

Hypoglycemic agents

           

Acarbose

Precose

50-200 mg po tid

25-200 mg po tid

Avoid

Avoid

No data

Acetohexamide

Dymelor

250-1,500 mg po q24h

Avoid

Avoid

Avoid

No data

Chlorpropamide

Diabinese

100-500 mg po q24h

50-250 mg po q24h

Avoid

Avoid

Avoid

Exenatide

Byetta

5-10 mcg SC bid

Same

Avoid

Avoid

Avoid

Glipizide

Glucotrol

2.5-15 mg po q24h

Same

1.25-7.5 mg po

1.25-7.5 mg po

Same

Glyburide

Diabeta, Glynase, Micronase, PresTab

1.25-20 mg po q24h

No data

No data

Avoid

Avoid

Insulin

 

Variable

100% of normal dose

75% of normal dose

50% of normal dose

No supplement necessary

Metformin

Glucophage

500-850 mg po bid

250-425 mg po bid

125-212 mg po bid

Avoid

No data

Tolazamide

Tolinase

100-250 mg po q24h

Same

Same

Same

No data

Tolbutamide

Orinase

1-2 g q24h

Same

Same

Same

No supplement necessary

Nonsteroidal anti-inflammatory agents

           

Diclofenac

Voltaren

25-75 mg po bid

12.5-37.5 mg po bid

6.25-37.5 mg po bid

6.25-18.75 mg po bid

No supplement necessary

Etodolac

Lodine

200 mg bid

Same

Same

Same

Same

Ibuprofen

Advil, Motrin

800 mg po tid

Same

Same

Same

Same

Indomethacin

Indocin

25-50 mg po tid

Same

Same

Same

Same

Ketorolac

Nabumetone

Toradol

Relafen

60 mg IM loading dose, then 15-30 mg q6h; 30 mg IV loading dose, then 15 mg q6h

Same

50% of normal dose

25-50% of normal dose

15 mg IM or IV q6h (no bolus dose)

Naproxen

Naprosyn

1-2 g po q24h

Same

0.5-1 g po q24h

0.5-1 g po q24h

No supplement necessary

Oxaprozin

Daypro

         

Tolmetin

Tolectin

500 mg bid

Same

Same

Same

Same

Proton pump inhibitors

 

1,200 mg po q24h

Same

Same

Same

Same

Esomeprazole

Nexium

400 mg po tid

Same

Same

Same

Same

Lansoprazole

Prevacid

         

Omeprazole

Prilosec

20-40 mg po q24h

Same

Same

Same

Same

Pantoprazole

Protonix

15-60 mg po q24h

Same

Same

Same

Same

     

20-60 mg po q24h

Same

Same

Same

Same

     

20-80 mg po q24h; 80 mg IV q12h

Same

Same

Same

Same

References

Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. Philadelphia, Pa.: American College of Physicians; 2007.

Micromedex Healthcare Series. Greenwood Village, Colo.: Thomson Healthcare. Available at: www.thomsonhc.com. Updated periodically.

UpToDate. Waltham, Mass.: Wolters Kluwer Health. Available at: www.uptodate.com. Updated periodically.