Principles of prescribing in kidney disease

Drug metabolism is altered in renal impairment and so doses and dosing intervals may need to be altered.

The best sources of information about prescribing in renal impairment are:

  • the BNF (tends to be conservative and is restricted to licensed indications)
  • the emc (licensed indications but more information than the BNF)
  • the Renal Drug Database (has information on unlicensed indications; this is the continually update and online version of the “Renal Drug Handbook”)
  • NHS Lothian shared care protocols
  • Lothian joint formulary (click on adult, child etc as appropriate; other useful links listed also)
  • the renal pharmacists

All doctors in NHS Scotland can (and should!) request access to the Renal Drug Database by e-mailing

In this prescribing handbook, we have further advice on some specific drugs / drug classes that have particular issues in renal disease:

  • ACE inhibitors / ARBs
  • antimicrobials
  • analgesia
  • anticoagulation
  • …and more

Acknowledgements:   Robert Hunter and Maggie Davidson were the main authors for this page. The last modified date is shown in the footer.