Drugs | Potential problems in renal failure patients | Remarks |
Antimicrobials | ||
Penicillin; cephalosporins; quinolones | • Confusion, seizure • Acute interstitial nephritis | • Dosage reduction required |
Vancomycin aminoglycosides | • Direct nephrotoxicity | • Therapeutic monitoring might facilitate dosage optimization |
Macrolides | • Prolongation of QTc • EnhanceCNI toxicity | • Monitor ECG changes • Monitor CNI drug levels |
Rifampicin | • Acute interstitial nephritis • Reduce CNI efficacy | Pre-emptive increase in CNI dosage and monitor drug levels to avoid renal graft rejection |
Acyclovir | • Confusion, crystallization in renal tubules | • Dosage reduction required |
Adefovir; tenofovir | • Renal deterioration; tubular defects | • Dosage reduction required |
Ganciclovir | • Severe marrow suppression | • Dosage reduction required |
Oseltamivir | • Gastrointestinal upset | • Dosage reduction required |
Amphotericin B | • Direct nephrotoxicityhypomagnesium, hypokalemia | • Dosage reduction and monitoring of electrolytes |
Drugs for cardiovascular diseases | ||
Digoxin | • Digoxin overdose (nausea, vomiting, yellow vision, arrhythmia) | • Dosage reduction required • Caution in patients with hypo/hyperkalemia |
ACEI/ARB/Spironolactone | • Renal deterioration, hyperkalemia | • Cautious in renal artery stenosis |
Chemotherapy & Immunosuppressive drugs | ||
Cyclophosphamide | • Severe marrow suppression | • Dosage reduction required |
Methotrexate | • Severe marrow suppression | • Dosage reduction required |
Calcineurin inhibitors (CNI) | • Acute and chronic nephrotoxicity | • Therapeutic drug monitoring useful |
Drugs for metabolic diseases | ||
Sulphonylurea | • Risk of hypoglycemia | • Dosage reduction required in mild renal impairment • Avoid in significant renal dysfunction |
Biguanides (metformin) | • Severe lactic acidosis | • Avoid in renal failure patients |
DDP-4 inhibitors (except linagliptin) | • Risk of hypoglycemia | • Dosage reduction required |
(PPAR-γ) agonists | • Precipitate fluid overload and congestive heart failure | • Avoid in CKD patients who are prone to fluid overload and have underlying cardiac failure |
Allopurinol | • Marrow suppression • Acute interstitial nephritis | • Dosage reduction required • Avoid concomitant azathioprine |
Drugs for gastrointestinal disease | ||
H2 antagonists | Confusion | Dosage reduction required |
Proton pump inhibitors | • Acute interstitial nephritis • Impaired absorption of other acidic drugs | • Monitoring of renal function • Discontinuation if interstitial nephritis |
Analgesics | ||
NSAIDS & COX2 inhibitors | • Direct nephrotoxicity, acute interstitial nephritis | • Avoid in renal failure patients |
Opioid analgesics | • Confusion & respiratory depression in patients with advanced CKD | • Avoid in advanced CKD patients |