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
  • 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