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 |
Aminoglycosides Vancomycin Aciclovir Digoxin Zidovudine |
Opiates (except fentanyl) | Cephalosporins Penicillins |
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
- Nitrofurantoin
- Fibrates
- Chloramphenicol
- Chloroquine
- Methotrexate
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.
Further info
- Notes on prescribing in renal disease from the Edren handbook