{"id":3619,"date":"2019-12-05T11:21:54","date_gmt":"2019-12-05T11:21:54","guid":{"rendered":"http:\/\/edren.org\/ren\/education\/textbook\/prescribing\/"},"modified":"2019-12-13T11:55:42","modified_gmt":"2019-12-13T11:55:42","slug":"prescribing","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/education\/textbook\/drugs-and-the-kidney\/prescribing\/","title":{"rendered":"Prescribing"},"content":{"rendered":"<p>Drugs that are predominantly renally excreted require lengthening of dose intervals or reduced maintenance doses &#8211; see datasheets or specialist resources for information on individual drugs.<\/p>\n<hr \/>\n<h3><strong><span style=\"color: #993300;\">Drugs requiring dose reductions<\/span><\/strong><\/h3>\n<p>Examples only! &#8211; not a complete list.<\/p>\n<table style=\"height: 165px; width: 90%;\" border=\"1\" width=\"90%\" cellspacing=\"0\" cellpadding=\"3\" align=\"center\">\n<tbody>\n<tr>\n<td style=\"border-color: #993300; border-style: solid; background-color: #e6f7ed;\" bgcolor=\"#ffff99\"><strong><span style=\"color: #993300;\">Mild renal failure<\/span><\/strong><\/td>\n<td style=\"border-color: #993300; border-style: solid; background-color: #e6f7ed;\" bgcolor=\"#ffff99\"><strong><span style=\"color: #993300;\">Moderate renal failure<\/span><\/strong><\/td>\n<td style=\"border-color: #993300; border-style: solid; background-color: #e6f7ed;\" bgcolor=\"#ffff99\"><strong><span style=\"color: #993300;\">Severe renal failure<\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"border-color: #993300; border-style: solid;\">Aminoglycosides<br \/>\nVancomycin<br \/>\nAciclovir<br \/>\nDigoxin<br \/>\nZidovudine<\/td>\n<td style=\"border-color: #993300; border-style: solid;\">Opiates (except fentanyl)<\/td>\n<td style=\"border-color: #993300; border-style: solid;\">Cephalosporins<br \/>\nPenicillins<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><strong><span style=\"color: #993300;\">Drugs to be avoided<\/span><\/strong><\/h3>\n<p>Sometimes the drug must be entirely avoided. Again note that these are examples, and mostly refer to moderate to advanced renal failure.<\/p>\n<ul style=\"list-style-type: disc;\">\n<li>NSAIDs in advanced renal failure (except when on dialysis; balance risk at intermediate GFR)<\/li>\n<li>Tetracyclines (except doxycycline and minocycline)<\/li>\n<li>Compounds containing aluminium, bismuth or lithium, except with cautious monitoring<\/li>\n<li>Nitrofurantoin<\/li>\n<li>Fibrates<\/li>\n<li>Chloramphenicol<\/li>\n<li>Chloroquine<\/li>\n<li>Methotrexate<\/li>\n<\/ul>\n<hr \/>\n<h3><strong><span style=\"color: #993300;\">Other prescribing notes<\/span><\/strong><\/h3>\n<p>ACE inhibitors and ARBs cause potassium retention and may cause hyperkalaemia.<\/p>\n<p>Diuretics are less effective in severe renal failure \u00e2\u20ac\u201c thiazides are less effective, loop diuretic doses often need to be increased. Potassium-sparing diuretics should be used with caution.<\/p>\n<hr \/>\n<h3><strong><span style=\"color: #993300;\">Further info<\/span><\/strong><\/h3>\n<ul>\n<li><a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/prescribing\/\">Notes on prescribing in renal disease<\/a>\u00a0from the Edren handbook<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Drugs that are predominantly renally excreted require lengthening of dose intervals or reduced maintenance doses &#8211; see datasheets or specialist resources for information on individual drugs. Drugs requiring dose reductions Examples only! &#8211; not a complete list. Mild renal failure Moderate renal failure Severe renal failure Aminoglycosides Vancomycin Aciclovir Digoxin\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/education\/textbook\/drugs-and-the-kidney\/prescribing\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3741,"menu_order":73,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-3619","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3619","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=3619"}],"version-history":[{"count":2,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3619\/revisions"}],"predecessor-version":[{"id":3659,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3619\/revisions\/3659"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/3741"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=3619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}