Dosage adjustments in adults related to creatinine clearance (degree of renal impairment): | |||
---|---|---|---|
Drug | 30–60 ml/min (mild) | 10–30 ml/min (moderate) | <10 ml/min (severe)i |
a The manufacturers recommend avoidance in “severe” renal impairment. Preliminary evidence suggests no dose change required for any level of renal impairment.48 | |||
b Further dose reductions if weight <60 kg. | |||
c Manufacturers recommend a loading dose and first dose reduction at CrCl <50 ml/min, second dose reduction ar CrCl <30 ml/min, third dose reduction at CrCl <15 ml/min | |||
d Further dose reduction to 25 mg once daily at CrCl <5 ml/min | |||
e These dose changes recommended at CrCl of <50 and <25 ml/min respectively | |||
f This dose recommended at CrCl <40 ml/min | |||
g The non-nucleoside reverse transcriptase inhibitors are primarily liver metabolised and plasma levels should not be affected by renal disease.49–51 Of the non-nucleoside reverse transcriptase inhibitors, only efavirenz is recommended by its manufacturers for use in renal disease with “caution” in “severe” renal impairment.45 | |||
h Protease inhibitors are liver metabolised and so dose adjustment is not necessary in renal disease.45–47 | |||
i Although data are limited, it is suggested that these doses also apply to haemodialysis and peritoneal dialysis and doses should be administered after haemodialysis.52 | |||
Nucleoside analogues | |||
Abacavira | No change | No change | No change48 |
Didanosineb | 200 mg once daily | 150 mg once daily | 100 mg once daily |
Lamivudinec | 150 mg once daily | 100 mg once daily | 50 mg once dailyd |
Stavudineb | 20 mg twice daily | 20 mg once dailye | 20 mg once daily |
Zalcitabine | No change | 0.75 mg twice dailyf | 0.75 mg once daily |
Zidovudine | No change | No change | 300–400 mg once daily |
Non-nucleoside RTI49–51 | |||
Delavirdineg | Unknown, theoretically no dose change required | ||
Efavirenzg | No change | No change | No change |
Nevirapineg | Unknown, theoretically no dose change required | ||
Protease inhibitorsh | |||
Amprenavir | No change | No change | No change |
Indinavir | No change | No change | No change |
Nelfinavir | No change | No change | No change |
Ritonavir | No change | No change | No change |
Saquinavir | No change | No change | No change |