Gabapentin Important drug interactions Clinical use
Anti-epileptic – adjunctive treatment of partial
• Antidepressants: antagonism of anticonvulsive
seizures with or without secondary generalisation
Administration Dose in normal renal function
300 mg on day 1, 300 mg twice daily on day 2,
300 mg three times daily on day 3, then increasedaccording to response to 1.2 g daily (in three
divided doses). If necessary may be further
increased in steps of 300 mg daily to a maximum2.4 g daily. Usual range 0.9–1.2 g daily; maximum
period between doses should not exceed 12
Neuropathic pain: loaded as above but maximum1.8 g daily
Pharmacokinetics Other information
• Can cause false positive readings with some
• In patients with moderate to severe renal
impairment, start with the lowest possible dose
and titrate upwards according to response
Dose in renal impairment GFR (mL/min) Dose in patients undergoing renal replacement therapies
Probably dialysed. Dose as in GFR < 15 mL/min
Dialysed. Loading dose of300–400 mg in patients who havenever received gabapentin. Maintenance dose of 200–300 mgafter each HD session
Dialysed. Dose as in GFR = 15–30 mL/min
Ganciclovir Important drug interactions Clinical use
• Increased risk of myelosuppression with other
• IV: treatment of life- or sight-threatening
• Profound myelosuppression with zidovudine
cytomegalovirus (CMV) in immunocompromised
• Generalised seizures reported with imipenem-
immunosuppressed patients secondary to organtransplantation
Administration
• Oral: maintenance treatment of CMV retinitis in
AIDS patients (licensed), prophylaxis and
• Reconstitute 1 vial (500 mg) with 10 mL water
immunosuppressed patients (unlicensed use)
Dose in normal renal function
• Then transfer dose to 100 mL sodium chloride 0.9%
• IV peripherally in fast-flowing vein or centrally –
Induction/Treatment of active CMV disease:
Maintenance for CMV retinitis: 6 mg/kg per day for
5 days per week or 5 mg/kg per day 7 days per week
Prevention of CMV retinitis: as per treatment
• May give 50% dose over 15 minutes after HD in
Maintenance for CMV retinitis, or prophylaxis inimmunosuppressed patients: 1000 mg three times
Other information Pharmacokinetics Creatinine clearance Dose (mL/min)
1.25mg/kg 24-hourly,given after haemodialysis
Dose in renal impairment GFR (mL/min) Creatinine clearance Dose (mL/min) Dose in patients undergoing renal replacement therapies
• Monitor patient for myelosuppression,
particularly in patients receiving prophylactic
• Pre-dialysis therapeutic blood levels in range
given post dialysis on dialysis days.
• Not to be infused in concentrations over
• Bioavailability of oral ganciclovir is 5%, so this should
only be used for maintenance/prophylactic therapy
Gemcitabine hydrochloride Clinical use Important drug interactions
Palliative treatment, or first-line treatment with
cisplatin, of locally advanced or metastatic non-
Treatment of bladder cancer in combination with
Administration Dose in normal renal function
• Reconstitute with sodium chloride 0.9%, 5 mL to
NSLC: 1000 mg/m2 weekly for 3 weeks, 1 weekrest then repeat
• Can be further diluted in sodium chloride 0.9% if
Pancreatic:1000 mg/m2 weekly for 7 weeks, restfor 1 week then weekly for 3 weeks out of 4
Pharmacokinetics Other information
• Gemcitabine causes reversible haematuria with
or without proteinuria in about 50% of patients
• There is no evidence for cumulative renal
Dose in renal impairment
toxicity with repeated dosing of gemcitabine
GFR (mL/min)
• Haemolytic uraemic syndrome (HUS) has been
reported with a crude incidence rate of 0.015%
• A study looking at the use of gemcitabine
500–1000 mg/m2 administered IV on days 1, 8
and 15 every 28 days in patients with renaldysfunction, concluded that this regimen was well
Dose in patients undergoing
tolerated in patients with a GFR as low as
renal replacement therapies
• Another study in patients with serum creatinines
in the range 130–420 micromol/L at doses of
650–800 mg/m2 weekly for 3 weeks out of a
4-week cycle, found dose-limiting toxicities,
including neutropenia, fever, raised transaminasesand increased serum creatinine. It was concluded
that a reduced dose of gemcitabine may be
appropriate in patients with established renalimpairment
Gemfibrozil Important drug interactions Clinical use
• Enhanced anticoagulant effect seen with
Hyperlipidaemias of types IIa, IIb, III, IV and V
• Ciclosporin: Parke-Davis have one report on file
Dose in normal renal function
of an interaction with ciclosporin where serumciclosporin levels were decreased. No effects on
1.2 g daily, usually in two divided doses;
Pharmacokinetics Administration Dose in renal impairment GFR (mL/min)
Initially 900 mg daily. Monitor carefully
Initially 900 mg daily. Monitor carefully
Other information Dose in patients undergoing
• Adverse effects have not been reported in
patients with renal disease, but such patients
renal replacement therapies
should start treatment at 900 mg daily, whichmay be increased after careful assessment of
• Rare cases of rhabdomyolysis may be increased
• Approximately 60–70% is excreted in the urine
• Gemfibrozil alone has caused myalgia and
myositis, but the effects appear to occur muchmore frequently and are more severe when anHMG CoA reductase inhibitor is also used.Thecombination is therefore not recommended
Gentamicin
• Cholinergics: antagonism of effect of neostigmine
• Botulinum toxin: neuromuscular block enhanced
Clinical use Administration Dose in normal renal function
3–7 mg/kg (ideal body weight) daily (divided into
1–4 doses). CAPD peritonitis – see local policy
• Bolus IV injection or short infusion – maximum
Pharmacokinetics
• Bolus IV: over not less than 3 minutes. Short
Other information Dose in renal impairment
• Adjustment for renal impairment: Dialysis patients –
GFR (mL/min)
See ‘Other information’ for dosage for dialysis andfor single daily dosing regimen
Dose in patients undergoing renal replacement therapies
• Concurrent penicillins may result in
• Monitor blood levels. 1 hour post-dose, peak
levels must not exceed 10 mg/L. Pre-dose trough
• Empirical IP therapy for CAPD peritonitis in
vancomycin IP at dose of 1–2 g stat on days 1and 7 of course. Monitoring of blood levels is
Important drug interactions
advisable, as absorption is increased by inflamedperitoneum
• Potential nephrotoxicity of the drug may worsen
• Ciclosporin: increased risk of nephrotoxicity
• Long-term concurrent use of gentamicin with
• Muscle relaxants: effect of tubocurarine enhanced
• Cytotoxics: increased risk of nephrotoxicity with
Glibenclamide Important drug interactions Clinical use
• Analgesics: azapropazone, phenylbutazone and
• Antibacterials: chloramphenicol, co-trimoxazole,
Dose in normal renal function
4-quinolones, sulphonamides and trimethoprimenhance effect
Initially 5 mg daily (elderly patients – 2.5 mg)adjusted according to response; maximum 15 mg
• Antifungals: fluconazole and miconazole increase
• Uricosurics: sulfinpyrazone enhances effect of
Pharmacokinetics Administration Dose in renal impairment GFR (mL/min)
Initial dose of 1.25–2.5 mg once a day.
Initial dose of 1.25–2.5 mg once a day. Monitor closely
Other information
Initial dose of 1.25–2.5 mg once a day. Use with caution with continuous
• The metabolites of glibenclamide are only weakly
hypoglycaemic, this is not clinically relevantwhere renal and hepatic functions are normal. If
Dose in patients undergoing
<10 mL/min, accumulation of metabolite
renal replacement therapies
and unchanged drug in plasma may causeprolonged hyperglycaemia
• Company information states that use is contra-
• Compensatory excretion via bile in faeces occurs
Unknown dialysability. Dose as inGFR = 10–20 mL/min
Gliclazide Important drug interactions Clinical use
• Analgesics: azapropazone, phenylbutazone and
• Antibacterials: chloramphenicol, co-trimoxazole,
Dose in normal renal function
4-quinolones, sulphonamides and trimethoprim
Initially: 40–80 mg daily, adjusted according to
response up to 160 mg as a single dose, with
• Antifungals: fluconazole and miconazole increase
breakfast; higher doses divided. Maximum 320 mg
• Uricosurics: sulfinpyrazone enhances effect
Pharmacokinetics Administration Dose in renal impairment GFR (mL/min)
Initially 20–40 mg daily. Use with cautionand monitor
Other information
Initially 20–40 mg daily. Use with cautionand monitor
• Care should be exercised in patients with hepatic
Initially 20–40 mg daily. Use with great
and/or renal impairment and a small starting
dose should be used with careful patientmonitoring
Dose in patients undergoing
• Company contra-indicates prescribing of
renal replacement therapies
Diamicron in severe renal impairment which theydefine as CL
Unlikely dialysability. Dose as inGFR = <10 mL/min
Unlikely dialysability. Dose as inGFR = <10 mL/min
Unknown dialysability. Dose as inGFR = 10–20 mL/min
Glimepiride Important drug interactions Clinical use
• Azapropazone, phenylbutazone and possibly
other NSAIDs enhance effect of sulphonylureas
• Antibacterials: chloramphenicol, co-trimoxazole,
Dose in normal renal function
4-quinolones, sulphonamides and trimethoprimenhance effect
1–4 mg daily. Maximum 6 mg daily taken shortlybefore or with first main meal
• Antifungals: fluconazole and miconazole increase
Pharmacokinetics Administration
% Excreted unchanged in urine 58–60 (as
Dose in renal impairment GFR (mL/min) Other information Dose in patients undergoing renal replacement therapies
Unlikely dialysability. Dose as inGFR = <10 mL/min
Unlikely dialysability. Dose as inGFR = <10 mL/min
Unlikely dialysability. Dose as inGFR = 10–20 mL/min
Glipizide Important drug interactions Clinical use
• Azapropazone, phenylbutazone and possibly
other NSAIDs enhance effect of sulphonylureas
• Antibacterials: chloramphenicol, co-trimoxazole,
Dose in normal renal function
4-quinolones, sulphonamides and trimethoprimenhance effect
Initially 2.5–5 mg daily, adjusted according toresponse; maximum 20 mg daily; up to 15 mg may
• Antifungals: fluconazole and miconazole increase
be given as a single dose before breakfast; higher
Pharmacokinetics Administration Dose in renal impairment GFR (mL/min) Other information
• Company does not recommend the use of
Dose in patients undergoing
Glibenese in patients with renal insufficiency
renal replacement therapies
• Renal or hepatic insufficiency may cause elevated
blood levels of glipizide (increased risk of serious
Dialysability insignificant, howevercontra-indicated if GFR<10 mL/min
Dialysability insignificant. Dose asin GFR = 10–20 mL/min
Granisetron Important drug interactions Clinical use
Prevention or treatment of nausea and vomitinginduced by cytotoxic chemotherapy, radiotherapy
Administration Dose in normal renal function
PO: 1–2 mg within 1 hour before start of
treatment, then 2 mg daily in 1–2 divided dosesduring treatment
IV: 3 mg before start of cytotoxic therapy, up to
• IV bolus: diluted in 5 mL sodium chloride 0.9%
two additional 3 mg doses can be given within
• IV infusion: 20–50 mL over 5 minutes
Operative procedures: IV: 1 mg before induction
of anaesthesia; treatment 1 mg (maximum 2 mg inone day)
• Compatible with sodium chloride 0.9%, sodium
chloride 0.18% and glucose 4% solution, glucose
Pharmacokinetics
5%, Hartmann’s solution, compound sodiumlactate, 10% mannitol
• Maximum administered dose over 24 hours
Other information
• No special dosing adjustments necessary in
Dose in renal impairment GFR (mL/min) Dose in patients undergoing renal replacement therapies
Unknown dialysability. Dose as innormal renal function
Unknown dialysability. Dose as innormal renal function. Companyrecommend timing HD for greaterthan 2 hours after granisetrondose
Unknown dialysability. Dose as innormal renal function
Griseofulvin Important drug interactions Clinical use
• Anticoagulants: metabolism of acenocoumarol
Antifungal agent: dermatophyte infections of the
and warfarin accelerated (reduced anticoagulant
• Metabolism of oral contraceptives accelerated
Dose in normal renal function
500 mg daily, in divided doses or as a single dose
• Ciclosporin: griseofulvin possibly reduces plasma
– ciclosporin concentration. (Two reports ofsuch an interaction in literature.)
Pharmacokinetics Administration Dose in renal impairment GFR (mL/min) Other information Dose in patients undergoing
• Use with extreme caution in patients with SLE
renal replacement therapies
Not dialysed. Dose as in normalrenal function
Not dialysed. Dose as in normalrenal function
Not dialysed. Dose as in normalrenal function
SCHOOL MEDICATION PERMIT For Lakota East Bands Only (In accordance with Ohio Revised Code 3313.713) The use of medication during school hours is discouraged. Use this form if it is essential a student receive medication during the school day. This section to be completed by the Parent or Guardian Name of Student: ___________________________________________Birthdate: _________
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