腎功能不全時應監測濃度，調整藥物劑量（但常被忽略）之藥物

腎功能不全時應監測濃度，調整藥物劑量（但常被忽略）之藥物
項次 藥物
ClCr <15 ml/min--2 mg on dailysis day <3 mg/min: 100 mg at extended intervals <10 ml/min-- in fast acetylators Q8-16H ClCr 30-50: 0.25 mg QD or 0.5 mg QOD (treatment-naive) ClCr <10: 0.05 mg QD or 0.5 Q7D (treatment-naive) 10-50 ml/min Q6-12H; <10 ml/min Q12-18H Clcr<25 ml/min:dosage adjustments may be necessary Clcr<25 ml/min:dosage adjustments may be necessary 1# QD in moderate renal impairment and in patients on 10-50 ml/min 75%; <10 ml/min 50% of the usual dose 10-50 ml/min <0.6 mg/day to every other day ClCr<30 ml/min not on hemodialysis: starting dose should be 5 milligrams (mg) once daily with titration not to lower dose and then increased gradually; not recommended for patients with end-stage renal disease (requiring dialysis) or severe renal impairment (ClCr<30 GFR 10 to 50 ml/min: 75% of the usual dose GFR <10 ml/min: 50% of the usual dose GFR >50 ml/min Q6H; 10-50 ml/min Q12H; <10 ml/min Clcr 5-29 ml/min: 5 mg ORALLY twice daily GFR 10 to 50 ml/min: Q24-36H; <10 ml/min Q48H GFR 10-70 ml/min: 75%; hemodialysis: 50% GFR 10-70 ml/min: 75%; hemodialysis: 50% Initial dose should be 50 mg QD in renal impairment Initial dose should be 50 mg QD in renal impairment Thiazides should not be used in patients with a serum creatinine or urea nitrogen level greater than 2.5 mg/Dl GFR <10 ml/min: 50%; 10-50 ml/min: 75% GFR 10 to 50 ml/mi: 75% ; <10 ml/min 50% Clcr<25 ml/min:dosage adjustments may be necessary Contraindicated in advanced renal impairment Adjustment for patients with a ClCr< 20 mL/minute <30 ml/min halved or the dosing interval doubled GFR 10 to 50 ml/min: 50 to 75%; <10 ml/min: 25 to 50% Initial dose should be 50 mg QD in renal impairment GFR 10 to 50 ml/min: 50%; <10 ml/min: 25% Initial dose should be 50 mg QD in renal impairment GFR10-50 ml/min: 50%; <10 ml/min: avoided The lower dose of 7.5 milligrams daily has been suggested GFR10-50 ml/min: 75%; <10 ml/min: 50% A reduction in daily dosage should be considered (Clcr<20 A reduction in daily dosage should be considered (Clcr<20 GFR> 50 ml/min: Q6H; 10 to 50 ml/min: Q12-18H; Potential need for dose adjustments in renal insufficiency Clcr 10 to 30 mL/min: 5 mg/day; < 10 mL/min: 2.5mg/day CrCl 20 to 40 ml/min: starting dose 0.5 mg ClCr>60 ml/min--4 mg/day; 30-60 ml/min--2 mg/day; 15-30 ml/min--2 mg/QOD; <15 ml/min--2 mg on dailysis GFR <10 ml/min: 50%; 10-50 ml/min: 75% Clcr<25 ml/min:dosage adjustments may be necessary < 40 ml/min (>2.5 mg/dL), oral dosing should be reduced Moderate: < 16 mg/day; severe (creatinine clearance < 9 Patients in renal failure may require higher than usual Dosage of sulfonamides be adjusted in patients with Serum creatinine is recommended to be maintained less ClCr 30 to 49 mL/min: 600 mg QOD; <30 mL/min: 600 mg Q72H; ESRD requiring hemodialysis: 600 mg Q96H, Clcr<50 ml/min: 50%; Clcr<25 ml/min: 25% > 50 mL/min Q6-12H; 10 to 50 mL/min Q12-24; <10 112 Superocin(Ciprofloxacin)250 mg 30-50 ml/min 250-500 mg Q12H; 5-29 ml/min 250-500 Slight reduction in the normal dose or by increasing the Clcr10-30 ml/min:treatment--75 mg/day; prophylaxis--75 > 50 ml/min Q8-12H; 10 to 50 ml/min Q12-24H; < 10 ml/min Q24H, but is best avoided in these patients One half of the usual adult dose is recommended Do not use extended-release tramadol in patients with severe renal impairment (creatinine clearance less than 30 < 30 ml/min: initiated at 300mg/day, one-half the usual starting dose, and increased at a slower rate than usual Clcr<30 ml/min: 25 mg (starting dose) Clcr 10 to 30 mL/min: 5 mg/day; < 10 mL/min: 2.5mg/day

Source: http://www.vhcy.gov.tw/vhcy/vhcy_dept5/code_upload/DHealthInfo1/file1_66_1714996.pdf