The primary message of this article is that renal function is an important physiological variable that predictably affects the pharmacokinetics and thus clinical effectiveness of some drugs.
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This article describes how to adjust drug dose to account for the pharmacokinetic changes that occur in renal disease.
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While not all these studies are published in peer-reviewed journals, the results can usually be obtained from the US Food and Drug Administration (FDA) databases. 5 Patient size is a particularly important factor to consider when using creatinine-based estimates of renal function.
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A review provides various drug dosing regimens and principles for appropriately treating patients with chronic kidney disease.
Firstly, patients with renal disease may be more vulnerable to a given drug effect (patient susceptibility).When prescribing for a patient with decreased renal function the characteristics of both the patient and the drug should be considered.
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Thus, if a drug is 100% renally cleared and renal function is half-normal, the drug dose should be halved, all other things being equal.
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Conversely, for drugs with a wide therapeutic index, even large changes in drug clearance may have only a modest impact on response, and therefore dose adjustments are less important.Drug doses should usually be reduced in renal disease in proportion to the predicted reduction in clearance of the active drug moiety.Be sure to place medications in a locked drawer or cabinet to avoid accidental.It should also be noted that product information sheets often have only crude dosing guidelines for renal impairment and sometimes specifically exclude patients with renal impairment (usually because these patients were excluded from the primary studies).
At AllTravelSizes find your favorite over the counter medications in travel friendly unit dose packets.To avoid harm when drug clearance is significantly decreased, the dose of renally cleared drugs should usually be reduced in patients with renal disease.For example, creatinine-based estimates of renal function are not reliable in pregnancy.Understanding and applying principles of good prescribing, such as those outlined above, allow recognition of potential problems, avoidance of drug toxicities and improvements in treatment efficacy.Increased drug clearance results in lower drug concentrations, while decreased drug clearance results in higher drug concentrations and hence greater drug effects.
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Estimates of renal function are useful to guide dosing of renally cleared drugs with medium therapeutic indices, but are not precise enough to guide dosing of drugs with narrow therapeutic indices.Find the most popular drugs, view ratings, user reviews, and more.
Other Information The effects of other variables that may influence drug dosing in renal disease, such as changes in urine pH and the role of drug transporters for secretion, are beyond the scope of this article.An estimate of renal function as an estimate of drug clearance provides useful guidance to dosing and can be used together with clinical and biochemical measures of effect (e.g. serum urate concentration).The Renal Drug Reference Guide. 1st edition. 2007. 15. Interactive Clinical Pharmacology (Accessed 11 February 2011). 16. NIH Clinical Center: Principles of Clinical Pharmacology (Accessed 11 February 2011). 17. Pharmacokinetic and Pharmacodynamic Resources (Accessed 11 February 2011).Inappropriate prescribing of primarily renally cleared medications in older patients with kidney disease can lead to adverse outcomes.
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Estimates of Renal Function For chronic kidney disease, estimates of renal function are used to predict disease outcome.In most cases it is calculated creatinine clearance using the Cockcroft and Gault equation, 10 as for many years this has been recommended by the FDA for pharmacokinetic calculations. 11 Although this situation may change, at the time of writing the Cockcroft and Gault equation underpins the majority of drug product information.Maraviroc should not be used in patients with severe renal impairment or end-stage.Common Oral Diabetes Medications. glimepiride should be dosed conservatively and dose changes should be based on fasting blood glucose concentrations.
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Methods of estimating renal function are discussed elsewhere in this journal. 1, 9 Drug Product Information Each drug is registered with product information for prescribers which encapsulates large amounts of research specific to that drug.