Drugs that are predominantly renally excreted require lengthening of dose intervals or reduced maintenance doses – see datasheets or specialist resources for information on individual drugs.
Drugs requiring dose reductions
Examples only! - not a complete list.
|Mild renal failure||Moderate renal failure||Severe renal failure|
|Opiates (except fentanyl)||Cephalosporins
Drugs to be avoided
Sometimes the drug must be entirely avoided. Again note that these are examples, and mostly refer to moderate to advanced renal failure.
- NSAIDs in advanced renal failure (except when on dialysis; balance risk at intermediate GFR)
- Tetracyclines (except doxycycline and minocycline)
- Compounds containing aluminium, bismuth or lithium, except with cautious monitoring
Other prescribing notes
ACE inhibitors and ARBs cause potassium retention and may cause hyperkalaemia.
Diuretics are less effective in severe renal failure – thiazides are less effective, loop diuretic doses often need to be increased. Potassium-sparing diuretics should be used with caution.
- Notes on prescribing in renal disease from the Edren handbook