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renal adjustments
na
47
Anatomy
Pre-School
11/06/2013
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Term
Acetaminophen: CrCl 10-50
 Definition
325-650 mg q 6 hours
Term
Acetaminophen: CrCl < 10
 Definition
325-650 mg q 8 hours
Term
Aspirin CrCl <10
 Definition
Avoid Use
Term
Allopurinol: CrCl 10-20
 Definition
Max 200 mg/day
Term
Allopurinol: CrCl <10
 Definition
Max 100 mg/day
Term
Allopurinol: CrCl <3
 Definition
Max 100 mg in extended doses
Term
Amoxicillin CrCl 10-30
 Definition
250-500 mg q12 hr
Term
Amoxicillin CrCl <10
 Definition
250-500 mg Q24 hr
Term
Digoxin: CrCl 10-50
 Definition
administer 35-75% dose or normal dose q 36 h
Term
Digoxin CrCl < 10
 Definition
administer 10%-25% dose or normal dose q48 dose
Term
Enoxaparin CrCl < 30
 Definition
1mg/kg once daily dosing
Term
Escitalopram CrCl < 20
 Definition
use caution (10 mg/day)
Term
Fexofenadine: CrCl <80 and >12 years old
 Definition
initial 60 mg qday
Term
Fexofenadine: CrCl < 80 and 2-11 years old
 Definition
initial 30 mg qday
Term
Fexofenadine: CrCl < 80 and 6 months-2 years old
 Definition
initial 15 mg qday
Term
Glipizide CrCl <50
 Definition
reduce dose by 50%
Term
Hydrochlorothiazide CrCl <10
 Definition
avoid use, may be ineffective under 30 mL/min
Term
Hydromorphone CrCl 30-60
 Definition
initiate with 50% dose
Term
Hydromorphone CrCl <30
 Definition
initiate with 25% dose
Term
Hydroxyzine CrCl <50
 Definition
administer 50% dose
Term
Insulin Lispro CrCl 10-50
 Definition
administer 75% dose
Term
Insulin Lispro CrCl <10
 Definition
administer 50% dose
Term
Levofloxacin CrCl 20-49
 Definition
administer 750 mg q 48 h
Term
Levofloxacin CrCl 10-19
 Definition
administer 750 initial, followed by 500 mg q48 h
Term
Lisinopril CrCl <30
 Definition
5 mg/day; with heart failure: 2.5 mg/day
Term
Metformin serum creatnine >1.5 in males, >1.4 in females
 Definition
contraindicated
Term
Methotrexate CrCl 10-50
 Definition
50% of dose
Term
Methotrexate CrCl <10
 Definition
Do not use
Term
Metoclopramide Cr Cl <40
 Definition
50% of the dose
Term
Atenolol CrCl 15-35
 Definition
max 50 mg/day
Term
Atenolol CrCl < 15
 Definition
max 25 mg/day
Term
Bisoprolol CrCl <40
 Definition
initial 2.5 mg/day
Term
Nebivolol CrCl <30
 Definition
initial 2.5 mg/day
Term
morphine sulfate CrCl 10-50
 Definition
75% normal dose
Term
morphine sulfate CrCl <10
 Definition
50% normal dose
Term
Nitrofurantoin CrCl <60
 Definition
contraindicated
Term
Piperacillin/tazobactam CrCl 20-40
 Definition
2.25 g q6h
Term
Piperacillin/tazobactam CrCl <20
 Definition
2.25 g q8h
Term
Ranitidine CrCl <50
 Definition
150 mg PO q24h
Term
Simvastatin CrCl <30
 Definition
initial 5 mg/day with close monitoring
Term
Rosuvastatin CrCl <30
 Definition
initial 5 mg/day, NTE 10 mg/day
Term
Pravastatin with "significant impairment"
 Definition
intitial dose 10 mg/day
Term
Lovastatin CrCl <30
 Definition
use caution and carefully consider doses > 20 mg/day
Term
Spironolactone CrCl >50
 Definition
initial dose 12.5-50 mg
Term
Spironolactone CrCl 30-49
 Definition
initial dose 12.5 mg daily
Term
Spironolactone CrCl <30
 Definition
not recommended
Term
Tramadol CrCl <30
 Definition
administer 50-100 mg q 12 h (max 200 mg/day)
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