|
Drug |
% Removed by Renal Clearance |
CrCl 50–79 ml/min |
CrCl 30–49 ml/min |
CrCl 10–29 ml/min |
CrCl <10 ml/min |
Post HD# dose |
|
Acyclovir (po) |
50 to 75% |
200-800mg 5x/d |
200-800mg q6h |
200-800mg q8h |
200-800mg q12h |
1 dose |
|
Acyclovir (iv) |
50 to 75% |
5mg/kg q8h |
5mg/kg q12h |
5mg/kg q24h |
2.5mg/kg q24h |
1 dose |
|
Amantadine |
> 75% |
100mg q24h |
100mg q24h |
100mg q72h |
100mg q7days |
none |
|
Ampicillin |
50 to 75% |
1g q6h |
1g q8h |
1g q12h |
1g q12-24h |
1 dose |
|
Amp/sulbactam |
50 to 75% |
1.5-3g q6-8h |
1.5-3g q6-8h |
1.5-3g q12h |
1.5-3g q24h |
1 dose |
|
Aztreonam |
50 to 75% |
1-2g q8h |
1-2g q8h |
1-2g q12h |
1-2g q24h |
1/8 dose |
|
Cefaclor |
> 75% |
500mg q8h |
500mg q8h |
250mg q8h |
250mg q8h |
250mg |
|
Cefazolin |
> 75% |
1g q8h |
1g q12h |
500mg q12h |
1g q24-48h |
0.5-1g |
|
Cefepime |
> 75% |
0.5-2g q12h** |
0.5-2g q24h |
0.5-1g q24h |
0.25-0.5g q24h |
1 dose |
|
Cefotaxime |
25 to 75% |
1-2g q8-12h |
1-2g q8-12h |
1-2g q12h |
1-2g q24h |
1g |
|
Cefoxitin |
> 75% |
1-2g q6-8h |
1-2g q8-12h |
1-2g q12-24h |
1-2g q24-48h |
1-2g |
|
Cefpodoxime |
> 75% |
100-200mg q12h |
100-200mg q12h |
100-200mg q24h |
100-200mg q24h |
none |
|
Ceftazidime |
> 75% |
1-2g q8-12h |
1-2g q12h |
1-2g q24h |
1-2g q48h |
1g |
|
Cefuroxime |
> 75% |
0.75-1.5g q8h |
0.75g q8h |
0.75g q12h |
0.75g q24h |
1 dose |
|
Cephalexin |
> 75% |
250-500mg q6h |
250-500mg q8h |
250-500mg q12h |
250-500mg q12h |
1 dose |
|
Cimetidine (iv/po) |
50 to 75% |
300mg q6-8h |
300mg q12h |
300mg q24h |
300mg q24h |
none |
|
Ciprofloxacin (po) |
50 to 75% |
500-750mg q12h |
500-750mg q12h |
500-750mg q24h |
500mg q24h |
none |
|
Ciprofloxacin (iv) |
50 to 75% |
200-400mg q12h |
200-400mg q12h |
200-400mg q24h |
200mg q24h |
none |
|
Famotidine (iv/po) |
50 to 75% |
20mg q12h |
20mg q12h |
20mg q12h |
20mg q24h |
none |
|
Fluconazole |
50 to 75% |
100-400mg q24h |
100-400mg q24h |
50-200mg q24h |
50-100mg q24h |
1 dose |
|
Flucytosine |
> 75% |
37.5mg/kg q6h |
37.5mg/kg q12h |
37.5mg/kg q18h |
37.5mg/kg q24h |
1 dose |
|
Gancyclovir |
50 to 75% |
2.5mg/kg q12h |
2.5mg/kg q24h |
1.25mg/kg q24h |
1.25mg/kg q48-96h |
1 dose |
|
Imipenem/cilastat. |
50 to 75% |
500mg q6h |
500mg q8h |
500mg q12h |
250mg q12h |
1 dose |
|
Levofloxacin |
> 75% |
500mg q24h |
250mg q24h |
250mg q36h |
250mg q48h |
250mg |
|
Nizatadine (treat) |
50 to 75% |
150mg q12h |
150mg q24h |
150mg q24h |
150mg q24h |
unknown |
|
Nizatadine (maint) |
50 to 75% |
150mg q12h |
150mg q48h |
150mg q48h |
150mg q72h |
unknown |
|
Penicillin |
50 to 75% |
2mU q4h |
1.5mU q4h |
1mU q4h |
0.5mU q4h |
0.5mU |
|
Pentamidine |
< 25% |
4mg/kg q24h |
4mg/kg q24-36h |
4mg/kg q24-36h |
4mg/kg q48h |
none |
|
Piperacillin |
50 to 75% |
3-4g q4-6h |
3-4g q8h |
3-4g q8-12h |
3-4g q12h |
1g dose |
|
Pip/tazocactam |
50 to 75% |
3.375-4.5g q6h |
2.25-3.375g q6h |
2.25g q6-8h |
2.25g q8h |
0.75g dose |
|
Ranitidine (po) |
50 to 75% |
150mg q12h |
150mg q24h |
150mg q24h |
150mg q24h |
1/2 dose |
|
Ranitidine (iv) |
50 to 75% |
50mg q8h |
50mg q18-24h |
50mg q24h |
50mg q24h |
1/2 dose |
|
TMP/SMZ (iv/po) |
25 to 75% |
normal dose |
normal dose |
1/2 normal dose |
1/2 normal dose q24 |
1 dose |
|
Tetracycline |
50 to 75% |
500mg q6h |
500mg q8-12h |
avoid use |
avoid use |
none |
|
Ticarcillin/clav |
> 75% |
3.1g q6h |
3.1g q6-8h |
3.1g q8-12h |
3.1g q12h |
1 dose |
|
#HD = Hemodialysis **adjust when CrCl falls below 60ml/min |
CrCl=(140-age) (IBW in kg) 72 (serum Cr) |
*multiply by 0.85 for females |
||||
If creatinine clearance is > 80 ml/min, use normal dose
Adapted from Drug Facts & Comparison. 1992:328-411 and Bennett, WM, Aronoff, GR et. al. Drug Prescribing in Renal Failure: Dosing for Adults. 3rd ed. 1994:18-79. AHFS Drug Information. 1996.
