Medications requiring dosage adjustments in renal insufficiency
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Many medications must be carefully monitored in the setting of compromised renal function. Clinical decision support has been shown in several studies to improve compliance with guidelines. A study by Roberts1 showed that clinical decision support, even outside of CPOE can improve conformity with ongoing education efforts in the academic setting.
References
KAISER PERMANENTE:SAFETY IN PRESCRIBING (SIP). Recommendations for dosing and drug alternatives. Dosing Recommendation in renal dysfunction. FEBRUARY 10, 2003 UPDATE.
Examples of Medications Requiring Dosage Adjustments in Renal Insufficiency | ==|||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Drug | GFR | Dosing recommendation in alert | Potential safety problem listed in alert |
---|---|---|---|
Allopurinol | 51-60
10-50 <10 |
200mg per day maximum
150mg per day maximum Do not use |
Liver and hematoligic toxicity.
|
Co-trimoxazole | 15-30
<15 |
80/400mg twice per day maximum
Do not use |
Crystalluria and kidney stone formation.
|
Metformin | <10 | Do not use | Lactic acidosis. |