Renal Dose Adjustments

*Based on GFR in ml/min/1.73m²

Acyclovir	30-50 10 mg/kg q 12 h	10-30 10 mg/kg q 24 h	below 10 5 mg/kg q 24 h
Allopurinol	30-50 Reduce dose by 50%	10-30 Reduce dose by 50%	below 10 Reduce dose by 75%
Amikacin	30-50 5-7.5 mg/kg q 12-18 h	10-30 5-7.5 mg/kg q 24 h	below 10 5-7.5 mg/kg q 48-72 h
Ampicillin	30-50 No change	10-30 25% of normal	below 10 15% of normal
Amoxicillin	30-50 No change	10-30 10-20 mg/kg/ dose q 12h	below 10 10-20 mg/kg/ dose q 24h
Atenolol	30-50 50% dose q 24 h	10-30 50% dose q 48 h	below 10 50% dose q 48 h
Azathioprine	30-50 Reduce dose by 25%	10-30 Reduce dose by 25%	below 10 Reduce dose by 50%
Co-amoxiclav	30-50 No change	10-30 Increase interval q 12 h	below 10 Increase interval q 24 h
Cefaclor	30-50 No change	10-30 No change	below 10 Reduce dose by 50%
Cefepime	30-50 50 mg/kg/dose q 24 h	10-30 50 mg/kg/dose q 24 h	below 10 50 mg/kg/dose q 48 h
Cefixime	30-50 No change	10-30 Reduce daily dose by 25%	below 10 Reduce daily dose by 50%
Cefotaxime	30-50 50 mg/kg/dose, q 8-12 h	10-30 50 mg/kg/dose, q 12 h	below 10 50 mg/kg/dose, q 24 h
Ceftazidime	30-50 50 mg/kg/dose q 12 h	10-30 50 mg/kg/dose q 24 h	below 10 50 mg/kg/dose q 48 h
Ceftriaxone	30-50 No change	10-30 No change	below 10 Reduce daily dose by 25-50%, q 24 h
Cefuroxime	30-50 No change	10-30 50 mg/kg/dose q 12 h	below 10 50 mg/kg/dose q 24 h
Cephalexin	30-50 5-10 mg/kg/dose q 8 h	10-30 5-10 mg/kg/dose q 12 h	below 10 5-10 mg/kg/dose q 24 h
Cefoperazone-sulbactam	30-50 No change	10-30 50% dose of sulbactam	below 10 25% dose of sulbactam
Ciprofloxacin	30-50 No change	10-30 Reduce daily dose by 50%	below 10 Reduce daily dose by 75%
Clonazepam	30-50 No change	10-30 No change	below 10 No change 75% dose
Cotrimoxazole	30-50 No change	10-30 5-10 mg/kg/dose, q 12h	below 10 Not recommended
Daptomycin	30-50 No change	10-30 4 mg/kg/dose q 24 h	below 10 4 mg/kg/dose q 24 h
Digoxin	30-50 75% dose	10-30 50% dose	below 10 25% dose
Enalapril	30-50 75% dose	10-30 75% dose	below 10 50% dose
Erythromycin	30-50 No change	10-30 No change	below 10 50% dose
Enoxaparin	30-50 No change	10-30 70% dose	below 10 50% dose q 24 h
Fluconazole	30-50 Reduce dose by 50%	10-30 Reduce dose by 50%	below 10 Reduce dose by 75%
30-50 q 12 h	10-30 q 18-24 h	below 10 q 24-48 h
Heparin	30-50 No change	10-30 No change	below 10 50% dose
Hydrochlorothiazide	30-50 No change	10-30 Avoid	below 10 Avoid
Imipenem-cilastatin	30-50 20 mg/kg q 8 h	10-30 10 mg/kg q 12 h	below 10 10 mg/kg q 12 h
Lamivudine	30-50 4 mg/kg q 24 h	10-30 2 mg/kg q 24 h	below 10 1 mg/kg q 24 h
Metronidazole	30-50 No change	10-30 No change	below 10 Reduce daily dose by 50%
Metoclopramide	30-50 Reduce dose by 25%	10-30 Reduce dose by 50%	below 10 Reduce dose by 75%
Meropenem	30-50 10-20 mg/kg q 12 h	10-30 10-20 mg/kg q 12 h	below 10 10-20 mg/kg q 24 h
Netilmicin	30-50 2 mg/kg q 12 h	10-30 2 mg/kg q 12 h	below 10 2 mg/kg q 24-48 h
Penicillin G	30-50 no change	10-30 Reduce daily dose by 25%	below 10 Reduce daily dose by 50%
Piperacillin- tazobactam	30-50 Reduce dose by 30% q 6 h	10-30 Reduce dose by 30% q 8 h	below 10 Reduce dose by 30% q 8 h
Prazosin	30-50 No change	10-30 No change	below 10 75% dose
Ramipril	30-50 No change	10-30 50% dose	below 10 25% dose
Ranitidine	30-50 Reduce dose by 25%	10-30 Reduce dose by 25%	below 10 Reduce dose by 50%
Teicoplanin	30-50 1-4 mg/kg q 24 h	10-30 1-4 mg/kg q 24 h	below 10 1 mg/kg q 24 h
Tobramycin	30-50 q 12 h	10-30 q 24 h	below 10 q 48 h
Vancomycin	30-50 10 mg/kg q 12 h	10-30 10 mg/kg q 24 h	below 10 10 mg/kg q 48-72
Ethambutol	30-50 No change	10-30 Increase interval q 36h	below 10 Increase interval q 48h
Pyrazinamide	30-50 No change	10-30 50% dose	below 10 Normal dose after hemodialysis for 3wks
Streptomycin	30-50 q 24-72 h	10-30 q 24-72 h	below 10 q 24-72 h
Clonazepam	30-50 No change	10-30 No change	below 10 75% dose
Lamotrigine	30-50 No change	10-30 No change	below 10 75% dose
Levetiracetam	30-50 50% dose	10-30 50% dose	below 10 50% dose
Topiramate	30-50 50% dose	10-30 50% dose	below 10 25% dose