Drug-Induced Nephrotoxicity

DRUG	% Renal Elimination			Comments	Indication	Renal Function (CrCl)	Dose
	<50	50–74	≥75	Comments	Indication	Renal Function (CrCl)	Dose
	<50	50–74	≥75
5-AMINOSALICYLIC ACID	•
ABACAVIR	•
ABATACEPT	•
ACAMPROSATE			•	Avoid in severe renal impairment
ACARBOSE	•
ACEBUTOLOL		•		Active metabolite; assume ≥75% renal elimination for dosage adjustment
ACETAMINOPHEN	•
ACETAZOLAMIDE			•	Avoid; ineffective when ClCr <10mL/min
ACITRETIN	•
ACYCLOVIR *Use Adj BW if patient obese for encephalitis meningitis			•		Encephalitis meningitis	> 50 mL/min




					General indications	> 50 mL/min





ADALIMUMAB	•
ADEFOVIR DIPIVOXIL	•			Nephrotoxic. Active metabolite; assume ≥75% renal elimination for dosage adjustment
ADENOSINE	•
ALBENDAZOLE	•
ALEMTUZUMAB	•
ALENDRONATE	•			Avoid in severe renal impairment
ALFACALCIDOL	•
ALFUZOSIN	•
ALIROCUMAB	•
ALISKIREN	•
ALLOPURINOL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
ALMOTRIPTAN			•
ALOGLIPTIN			•	Active metabolite
ALPRAZOLAM	•
ALPROSTADIL	•
ALTEPLASE	•
ALUMINUM SALTS	•			Avoid in severe renal impairment as may accumulate
AMANTADINE			•
AMIKACIN			•	Nephrotoxic; monitor serum drug concentrations
AMILORIDE		•		Avoid in severe renal impairment
AMINOPHYLLINE	•
AMIODARONE	•			Active metabolite but no dosage adjustment required
AMITRIPTYLINE	•			Active metabolite but no dosage adjustment required
AMLODIPINE	•
AMOXICILLIN		•
AMOXICILLIN/CLAVULANATE		•
AMPHETAMINE, MIXED SALTS		•		Active metabolite but no dosage adjustment required
AMPHOTERICIN B	•			Nephrotoxic
AMPICILLIN			•
ANAKINRA			•
ANIDULAFUNGIN	•
APIXABAN	•
APOMORPHINE	•			Manufacturer recommends lower starting doses in mild and moderate renal impairment and that the drug not be used in severe renal impairment
APREMILAST	•			Manufacturer recommends dose reduction in severe renal impairment
APREPITANT	•
ARIPIPRAZOLE	•
ASA	•			Nephrotoxic
ASENAPINE	•
ATAZANAVIR	•
ATENOLOL			•
ATOMOXETINE	•
ATORVASTATIN	•			Active metabolite but no dosage adjustment required
ATOVAQUONE	•
ATROPINE	•
AURANOFIN			•	Avoid; nephrotoxic
AZATHIOPRINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
AZILSARTAN	•
AZITHROMYCIN	•
BACLOFEN			•
BARICITINIB			•	Manufacturer recommends avoiding use if ClCr <60 mL/min
BAZEDOXIFENE	•
BELIMUMAB	•
BENAZEPRIL	•
BENRALIZUMAB	•
BENZTROPINE	•
BEZAFIBRATE		•		Avoid in renal impairment
BICTEGRAVIR	•			Manufacturer recommends avoiding use if ClCr <30 mL/min
BILASTINE	•
BISACODYL	•			Active metabolite but no dosage adjustment required
BISMUTH SUBSALICYLATE	•
BISOPROLOL		•
BIVALIRUDIN	•			Reduce dose in severe renal impairment
BREXPIPRAZOLE	•			Manufacturer recommends reducing dose by 25–33% when ClCr <60 mL/min
BRINZOLAMIDE		•		Eye drops; contraindicated in severe renal impairment
BRIVARACETAM	•
BROMOCRIPTINE	•
BROMPHENIRAMINE	•
BUDESONIDE	•
BUMETANIDE	•			Larger doses may be required in severe renal impairment
BUPRENORPHINE	•
BUPROPION	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
BUSERELIN	•
BUSPIRONE	•
BUTALBITAL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
CABOTEGRAVIR	•
CAFFEINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
CALCITONIN	•
CALCITRIOL	•
CALCIUM SALTS	•
CANAGLIFLOZIN	•			Less effective in moderate and ineffective in severe renal impairment
CANDESARTAN	•
CAPTOPRIL		•
CARBAMAZEPINE	•			Active metabolite but no dosage adjustment required
CARVEDILOL	•			Active metabolite but no dosage adjustment required
CASCARA				Route of elimination unknown
CASPOFUNGIN	•
CEFADROXIL			•
CEFAZOLIN			•
CEFEPIME			•
CEFIXIME		•
CEFOTAXIME		•		Active metabolite; assume ≥75% renal elimination for dosage adjustment
CEFOXITIN			•
CEFPROZIL		•
CEFTAZIDIME			•
CEFTRIAXONE	•
CEFUROXIME			•
CELECOXIB	•			Nephrotoxic
CEPHALEXIN			•
CERTOLIZUMAB PEGOL	•			Polyethylene glycol component renally eliminated
CETIRIZINE		•
CHLORAL HYDRATE	•			Avoid. Active metabolite; assume ≥75% renal elimination for dosage adjustment
CHLORDIAZEPOXIDE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
CHLOROQUINE		•
CHLORPHENIRAMINE	•
CHLORPROMAZINE	•			Active metabolite but no dosage adjustment required
CHLORTHALIDONE		•		Avoid; ineffective when ClCr <30 mL/min
CHLORZOXAZONE	•
CHROMIUM			•
CIDOFOVIR			•	Avoid; nephrotoxic. Active metabolite; assume ≥75% renal elimination for dosage adjustment
CILAZAPRIL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
CIMETIDINE		•
CINACALCET	•
CIPROFLOXACIN		•
CITALOPRAM	•
CLADRIBINE	•			Not recommended if ClCr <60 mL/min
CLARITHROMYCIN	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
CLINDAMYCIN	•
CLOBAZAM	•
CLODRONATE			•	Avoid; nephrotoxic
CLOMIPHENE	•
CLOMIPRAMINE	•			Active metabolite but no dosage adjustment required
CLONAZEPAM	•
CLONIDINE	•
CLOPIDOGREL	•
CLOXACILLIN	•
CLOZAPINE	•			Active metabolite but no dosage adjustment required
COBICISTAT	•
CODEINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
COENZYME Q10	•
COLCHICINE	•			Avoid in renal impairment
CYANOCOBALAMIN		•		% renal elimination increased with large doses
CYCLOBENZAPRINE	•
CYCLOPHOSPHAMIDE	•			Active metabolite; dosage adjustment recommended in severe renal impairment
CYCLOSPORINE	•			Nephrotoxic; monitor serum drug concentrations
CYPROHEPTADINE	•
CYPROTERONE ACETATE	•
CYTISINE				Route of elimination unknown
DABIGATRAN			•	Contraindicated in severe renal impairment
DALTEPARIN			•
DANAZOL	•
DANTROLENE	•
DAPAGLIFLOZIN	•			Contraindicated in moderate to severe renal impairment
DAPSONE	•
DAPTOMYCIN			•
DARBEPOETIN ALFA	•
DARIFENACIN	•
DARUNAVIR	•
DEFEROXAMINE			•
DELAVIRDINE	•
DELTA-9-TETRAHYDROCANNABINOL/CANNABIDIOL	•
DENOSUMAB	•
DESIPRAMINE	•			Active metabolite but no dosage adjustment required
DESLORATADINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
DESMOPRESSIN			•
DESVENLAFAXINE	•			Manufacturer recommends dosage adjustment if ClCr <30 mL/min, although <50% renal elimination
DEXAMETHASONE	•
DEXBROMPHENIRAMINE	•
DEXLANSOPRAZOLE	•
DEXRAZOXANE	•			Reduce dose by 50% in patients with moderate to severe renal impairment
DEXTROAMPHETAMINE		•		Active metabolite but no dosage adjustment required
DEXTROMETHORPHAN	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
DIAZEPAM	•			Active metabolite but no dosage adjustment required
DICLOFENAC	•			Nephrotoxic
DICYCLOMINE			•
DIDANOSINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
DIENOGEST	•
DIFLUNISAL	•			Nephrotoxic
DIGOXIN			•	Monitor serum concentrations
DIHYDROERGOTAMINE	•			Active metabolite; no data on renal elimination
DILTIAZEM	•			Active metabolite but no dosage adjustment required
DIMENHYDRINATE	•
DIMETHYL FUMARATE	•
DIPHENHYDRAMINE	•
DIPHENOXYLATE	•			Active metabolite
DIPYRIDAMOLE	•
DISULFIRAM	•
DIVALPROEX	•
DOBUTAMINE	•
DOCUSATE	•
DOFETILIDE			•
DOLUTEGRAVIR	•
DOMPERIDONE	•
DONEPEZIL	•			Active metabolite but no dosage adjustment required
DORAVIRINE	•
DOXAZOSIN	•
DOXEPIN	•			Active metabolite but no dosage adjustment required
DOXYCYCLINE	•
DOXYLAMINE	•
DRONEDARONE	•
DULAGLUTIDE	•
DULOXETINE	•			Use contraindicated by manufacturer if ClCr <30 mL/min
DUTASTERIDE	•
EDOXABAN		•
EFAVIRENZ	•
ELAGOLIX	•
ELETRIPTAN	•
ELUXADOLINE	•
ELVITEGRAVIR	•
EMPAGLIFLOZIN		•		Less effective in moderate and ineffective in severe renal impairment
EMTRICITABINE			•
ENALAPRIL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
ENFUVIRTIDE	•
ENOXAPARIN			•
ENTACAPONE	•
ENTECAVIR		•
EPLERENONE	•			Use contraindicated by manufacturer if ClCr <30 mL/min
EPOETIN ALFA	•
EPROSARTAN	•
EPTIFIBATIDE	•			Dosage adjustment recommended for patients with renal impairment
EPTINEZUMAB	•
ERENUMAB	•
ERTAPENEM			•
ERTUGLIFLOZIN		•		Less effective in moderate, and ineffective in severe renal impairment
ERYTHROMYCIN	•
ESCITALOPRAM	•			Active metabolite but no dosage adjustment required
ESKETAMINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
ESLICARBAZEPINE			•
ESMOLOL	•
ESOMEPRAZOLE	•
ESTROGENS	•
ESZOPICLONE			•
ETANERCEPT	•
ETHACRYNIC ACID	•			Avoid in severe renal impairment
ETHAMBUTOL		•
ETHOPROPAZINE				Route of elimination unknown
ETHOSUXIMIDE	•
ETIDRONATE		•		Nephrotoxic
ETODOLAC	•			Nephrotoxic
ETRAVIRINE	•
EVOLOCUMAB	•
EXENATIDE			•	Avoid in severe renal impairment
EZETIMIBE	•
FAMCICLOVIR	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
FAMOTIDINE			•
FAMPRIDINE			•	Use contraindicated by manufacturer if ClCr <60 mL/min
FATTY ACIDS, OMEGA-3	•
FEBUXOSTAT	•
FELODIPINE	•
FENOFIBRATE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
FENTANYL	•
FESOTERODINE		•		Active metabolite
FEXOFENADINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
FIDAXOMICIN	•
FILGRASTIM	•
FINASTERIDE	•
FINGOLIMOD	•
FLECAINIDE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
FLUCONAZOLE		•
FLUCYTOSINE			•
FLUDROCORTISONE	•
FLUNARIZINE	•
FLUOXETINE	•			Active metabolite but no dosage adjustment required
FLUPENTIXOL	•
FLUPHENAZINE	•
FLURAZEPAM	•			Active metabolite but no dosage adjustment required
FLURBIPROFEN	•			Nephrotoxic
FLUTAMIDE	•
FLUVASTATIN	•
FLUVOXAMINE	•
FOLIC ACID	•			% renal elimination increased with large doses
FONDAPARINUX			•
FOSAMPRENAVIR	•
FOSAPREPITANT	•
FOSCARNET			•	Avoid; nephrotoxic
FOSFOMYCIN	•
FOSINOPRIL	•			Active metabolite but no dosage adjustment required
FREMANEZUMAB	•
FROVATRIPTAN	•
FUROSEMIDE		•		Larger doses may be required in severe renal impairment
GABAPENTIN			•
GALANTAMINE	•			Manufacturer recommends a maximum daily dose of 16 mg if ClCr <60 mL/min
GALCANEZUMAB	•
GANCICLOVIR			•
GEMFIBROZIL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
GENTAMICIN			•	Nephrotoxic; monitor serum drug concentrations
GLATIRAMER	•
GLICLAZIDE	•
GLIMEPIRIDE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
GLUCOSAMINE	•
GLYBURIDE	•			Avoid. Active metabolite but no dosage adjustment required
GLYCOPYRROLATE	•
GOLIMUMAB	•
GOSERELIN	•
GRANISETRON	•
GUAIFENESIN				Route of elimination unknown
GUANFACINE		•
GUSELKUMAB	•
HALOPERIDOL	•
HEPARIN	•
HYDRALAZINE	•
HYDROCHLOROTHIAZIDE			•	Avoid; ineffective when ClCr <30 mL/min
HYDROCODONE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
HYDROCORTISONE	•
HYDROMORPHONE	•
HYDROXYCHLOROQUINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
HYDROXYZINE		•
HYOSCINE	•
IBUPROFEN	•			Nephrotoxic
IBUTILIDE	•			Active metabolite but no dosage adjustment required
ICOSAPENT ETHYL	•
IMIPENEM/CILASTATIN		•
IMIPRAMINE	•			Active metabolite but no dosage adjustment required
INDAPAMIDE	•			Avoid; ineffective when ClCr <30 mL/min
INDOMETHACIN	•			Nephrotoxic
INFLIXIMAB	•
INSULIN	•
INTERFERON ALFA	•
INTERFERON BETA	•
IODINE			•
IRBESARTAN	•
IRON SALTS	•
ISONIAZID	•
ISOSORBIDE DINITRATE OR 5-MONONITRATE	•			Active metabolite but no dosage adjustment required
ISOTRETINOIN	•			Avoid in renal impairment
ITRACONAZOLE	•
IVABRADINE	•			Active metabolite; no data available for ClCr <15 mL/min
IXEKIZUMAB	•
KETOCONAZOLE	•
KETOPROFEN	•			Nephrotoxic
KETOROLAC			•	Nephrotoxic
KETOTIFEN		•
L-CARNITINE			•
L-TRYPTOPHAN	•
LABETALOL	•
LACOSAMIDE			•	Manufacturer recommends a maximum daily dose of 300 mg in patients with end-stage renal disease
LAMIVUDINE		•		Active metabolite; assume ≥75% renal elimination for dosage adjustment
LAMOTRIGINE	•
LANREOTIDE	•
LANSOPRAZOLE	•
LEFLUNOMIDE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
LEMBOREXANT	•
LETERMOVIR	•
LETROZOLE	•
LEUPROLIDE	•
LEVETIRACETAM		•
LEVODOPA	•			Active metabolite but no dosage adjustment required
LEVOFLOXACIN			•
LEVOMILNACIPRAN		•
LEVONORGESTREL	•
LEVOTHYROXINE	•
LIDOCAINE	•			Active metabolite but no dosage adjustment required
LINAGLIPTIN	•
LINEZOLID	•
LIOTHYRONINE				No data on renal elimination
LIRAGLUTIDE	•
LISDEXAMFETAMINE	•
LISINOPRIL			•
LITHIUM			•	Nephrotoxic; monitor serum drug concentrations
LIXISENATIDE		•		No dosage adjustment required if ClCr >30 mL/min; no data available for ClCr <30 mL/min
LOPERAMIDE	•
LOPINAVIR/RITONAVIR	•
LORATADINE	•			Active metabolite; consider dosage adjustment in severe renal impairment
LORAZEPAM	•
LOSARTAN	•			Active metabolite but no dosage adjustment required
LOVASTATIN	•
LOXAPINE	•
LURASIDONE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
MAGNESIUM SALTS	•			Avoid in severe renal impairment as may accumulate
MARAVIROC	•			Modify dose when taking concurrent potent CYP3A4 inhibitors
MEBENDAZOLE	•
MEDROXYPROGESTERONE	•
MEFENAMIC ACID	•			Nephrotoxic
MEFLOQUINE	•
MEGESTROL	•
MELATONIN	•
MELOXICAM	•			Nephrotoxic
MEMANTINE			•
MEPERIDINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
MEPOLIZUMAB	•
MERCAPTOPURINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
MEROPENEM		•
MESNA			•
METFORMIN			•	Avoid in severe renal impairment
METHADONE	•
METHAZOLAMIDE	•			Avoid; ineffective in severe renal impairment
METHIMAZOLE	•
METHOCARBAMOL	•
METHOTREXATE			•	Avoid; nephrotoxic
METHOTRIMEPRAZINE	•			Active metabolite but no dosage adjustment required
METHYLDOPA	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
METHYLNALTREXONE		•
METHYLPHENIDATE	•
METHYLPREDNISOLONE	•
METOCLOPRAMIDE			•	Active metabolite; assume ≥75% renal elimination for dosage adjustment
METOLAZONE		•		Dosage reduction not necessary in renal impairment
METOPROLOL	•
METRONIDAZOLE	•			Active metabolite but no dosage adjustment required
MEXILETINE	•			Active metabolite but no dosage adjustment required
MICAFUNGIN	•
MICONAZOLE	•
MIDAZOLAM	•
MIDODRINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
MILRINONE			•
MINOCYCLINE	•
MIRABEGRON	•			Manufacturer recommends a maximum daily dose of 25 mg in patients with severe renal impairment
MIRTAZAPINE			•
MISOPROSTOL	•
MITOXANTRONE	•
MOCLOBEMIDE	•
MONTELUKAST	•
MORPHINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
MOXIFLOXACIN	•
MYCOPHENOLATE	•
NABILONE	•
NABUMETONE	•			Nephrotoxic. Active metabolite; assume ≥75% renal elimination for dosage adjustment
NADOLOL			•
NADROPARIN			•
NAFARELIN	•
NALOXEGOL	•			Manufacturer recommends 50% reduction of initial dose in moderate or severe renal impairment
NALOXONE	•
NALTREXONE	•			Active metabolite but no dosage adjustment required
NAPROXEN	•			Nephrotoxic
NARATRIPTAN		•
NATALIZUMAB	•
NEBIVOLOL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
NELFINAVIR	•			Active metabolite but no dosage adjustment required
NEVIRAPINE	•
NIACIN	•
NICOTINE	•
NIFEDIPINE	•
NIMODIPINE	•
NITAZOXANIDE	•			Active metabolite
NITROFURANTOIN	•			Avoid in renal impairment
NITROGLYCERIN	•
NITROPRUSSIDE	•
NIZATIDINE		•
NORETHINDRONE	•
NORFLOXACIN			•
NORTRIPTYLINE	•			Active metabolite but no dosage adjustment required
OCRELIZUMAB	•
OCTREOTIDE	•			Reduce dose in severe renal impairment
OLANZAPINE	•
OLMESARTAN	•			Not recommended in severe renal impairment
OLSALAZINE	•
OMALIZUMAB	•
OMEPRAZOLE	•
ONDANSETRON	•
ORLISTAT	•
ORPHENADRINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
OSELTAMIVIR	•			Active metabolite; dosage adjustment recommended in severe renal impairment
OXAZEPAM	•
OXCARBAZEPINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
OXTRIPHYLLINE	•
OXYBUTYNIN	•			Active metabolite but no dosage adjustment required
OXYCODONE	•
OXYMETAZOLINE				Route of elimination unknown
PALIPERIDONE		•		Manufacturer recommends dosage adjustment in renal impairment
PALONOSETRON			•	Active metabolite but no dosage adjustment required
PAMIDRONATE		•		Nephrotoxic
PANTOPRAZOLE	•
PAROXETINE	•
PEGFILGRASTIM	•			Polyethylene glycol component renally eliminated
PEGINTERFERON ALFA	•			Polyethylene glycol component renally eliminated
PENICILLAMINE	•			Avoid; nephrotoxic
PENICILLIN G/V		•
PENTAMIDINE	•			Nephrotoxic when given IV
PENTAZOCINE	•
PENTOXIFYLLINE	•
PERAMPANEL	•
PERINDOPRIL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
PERPHENAZINE	•
PHENELZINE	•
PHENIRAMINE			•
PHENOBARBITAL	•			Active metabolite but no dosage adjustment required
PHENYLEPHRINE	•
PHENYTOIN	•
PILOCARPINE	•
PIMOZIDE	•
PINAVERIUM BROMIDE	•
PINDOLOL	•
PIOGLITAZONE	•
PIPERACILLIN			•
PIPERACILLIN/TAZOBACTAM			•
PIROXICAM	•			Nephrotoxic
PIZOTIFEN	•
POSACONAZOLE	•
POTASSIUM SALTS			•	May accumulate in renal impairment
PRAMIPEXOLE			•
PRASUGREL	•			Active metabolite but no dosage adjustment required
PRAVASTATIN	•
PRAZOSIN	•
PREDNISONE	•
PREGABALIN			•
PRIMAQUINE	•
PRIMIDONE	•			Active metabolite but no dosage adjustment required
PROBENECID			•	Ineffective when ClCr <50 mL/min
PROCAINAMIDE		•		Active metabolite; assume ≥75% renal elimination for dosage adjustment
PROCHLORPERAZINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
PROCYCLIDINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
PROGESTERONE	•
PROGUANIL	•			Active metabolite but no dosage adjustment required
PROMETHAZINE	•
PROPAFENONE	•
PROPRANOLOL	•
PROPYLTHIOURACIL	•
PRUCALOPRIDE		•
PSEUDOEPHEDRINE			•
PYRAZINAMIDE	•			Avoid in severe renal impairment
PYRIDOXINE		•		% renal elimination increased with large doses
QUETIAPINE	•
QUINAPRIL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
QUINIDINE	•			Active metabolite but no dosage adjustment required
QUININE	•
QUINUPRISTIN/DALFOPRISTIN	•
RABEPRAZOLE	•
RALOXIFENE	•
RALTEGRAVIR	•
RAMIPRIL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
RANITIDINE		•
RASAGILINE	•			Conclusive data not available for renally impaired patients
RASBURICASE	•
REMDESIVIR	•			Active metabolite. The excipient betadex sulfobutyl ether may accumulate in severe renal impairment
REPAGLINIDE	•
RESLIZUMAB	•
RIBAVIRIN	•			Avoid in renal impairment
RIBOFLAVIN		•
RIFABUTIN	•			Active metabolite but no dosage adjustment required
RIFAMPIN	•			Active metabolite but no dosage adjustment required
RILPIVIRINE	•
RISANKIZUMAB	•
RISEDRONATE			•	Avoid in severe renal impairment
RISPERIDONE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
RITONAVIR	•			Active metabolite but no dosage adjustment required
RITUXIMAB	•			Nephrotoxic
RIVAROXABAN	•			Avoid in severe renal impairment
RIVASTIGMINE	•
RIZATRIPTAN	•			Active metabolite but no dosage adjustment required
ROFLUMILAST	•
ROMOSOZUMAB	•
ROPINIROLE	•
ROSIGLITAZONE	•
ROSUVASTATIN	•
ROTIGOTINE	•
RUFINAMIDE	•
RUPATADINE	•			Active metabolite; not studied in renal impairment
SACUBITRIL/VALSARTAN		•
SAFINAMIDE	•
SAQUINAVIR	•
SARILUMAB	•
SAXAGLIPTIN	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
SCOPOLAMINE	•
SECUKINUMAB	•
SELEGILINE	•			Active metabolite but no dosage adjustment required
SEMAGLUTIDE	•
SENNA				% renally eliminated unknown
SERTRALINE	•
SILDENAFIL	•
SILODOSIN	•
SIMVASTATIN	•
SIPONIMOD	•
SITAGLIPTIN			•
SODIUM PHOSPHATES				% renally eliminated unknown; may accumulate in renal impairment
SOFOSBUVIR			•	No dose adjustment recommended in mild and moderate renal impairment
SOLIFENACIN		•		Active metabolite
SOTALOL		•
SPECTINOMYCIN			•	Dosage adjustment unnecessary
SPIRONOLACTONE	•			Avoid. Active metabolite; assume ≥75% renal elimination for dosage adjustment
STAVUDINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
STIRIPENTOL	•
STREPTOMYCIN			•	Nephrotoxic; monitor serum drug concentrations
SUCRALFATE	•			Al⁺⁺ may accumulate
SULFADIAZINE		•		Nephrotoxic
SULFAMETHOXAZOLE/TRIMETHOPRIM		•
SULFASALAZINE	•			Active metabolite but no dosage adjustment required
SULFINPYRAZONE	•			Avoid; nephrotoxic
SULINDAC	•			Nephrotoxic. Active metabolite but no dosage adjustment required
SUMATRIPTAN	•
TACROLIMUS	•
TADALAFIL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
TAMSULOSIN	•
TAPENTADOL	•			Not recommended in severe renal impairment
TELBIVUDINE			•
TELMISARTAN	•
TEMAZEPAM	•
TENECTEPLASE	•
TENOFOVIR			•	Nephrotoxic
TENOXICAM	•			Nephrotoxic
TERAZOSIN	•
TERBINAFINE		•
TERIFLUNOMIDE	•
TERIPARATIDE	•			Do not use if ClCr <30 mL/min
TETRACYCLINE		•		Nephrotoxic
THEOPHYLLINE	•
THIAMINE	•
TIAPROFENIC ACID			•	Nephrotoxic
TICAGRELOR	•
TIGECYCLINE	•
TIMOLOL	•
TINZAPARIN			•
TIPRANAVIR	•
TIROFIBAN		•
TIZANIDINE	•
TOBRAMYCIN			•	Nephrotoxic; monitor serum drug concentrations
TOCILIZUMAB	•
TOFACITINIB	•			Manufacturer recommends dosage adjustment in moderate or severe renal impairment
TOLBUTAMIDE	•
TOLTERODINE	•
TOPIRAMATE			•
TRAMADOL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
TRANDOLAPRIL	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
TRANEXAMIC ACID			•
TRANYLCYPROMINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
TRAZODONE	•
TRIAMTERENE	•			Avoid; nephrotoxic. Active metabolite but no dosage adjustment required
TRIAZOLAM	•
TRIENTINE	•
TRIFLUOPERAZINE	•
TRIHEXYPHENIDYL			•
TRIMEPRAZINE	•
TRIMETHOPRIM			•
TRIMIPRAMINE	•
TRIPROLIDINE	•
TRIPTORELIN	•			Conclusive data not available for renally impaired patients but dosage adjustment may be required
TROSPIUM	•			Conclusive data not available for renally impaired patients but dosage adjustment may be required
ULIPRISTAL	•
UPADACITINIB	•
URSODEOXYCHOLIC ACID	•
USTEKINUMAB	•
VALACYCLOVIR	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
VALGANCICLOVIR		•		Nephrotoxic. Active metabolite; assume ≥75% renal elimination for dosage adjustment
VALPROIC ACID	•
VALSARTAN	•
VANCOMYCIN			•	Nephrotoxic; monitor serum drug concentrations
VARDENAFIL	•
VARENICLINE			•
VASOPRESSIN	•
VEDOLIZUMAB	•
VENLAFAXINE	•			Active metabolite; assume ≥75% renal elimination for dosage adjustment
VERAPAMIL	•			Active metabolite but no dosage adjustment required
VERTEPORFIN	•
VIGABATRIN			•
VILAZODONE	•
VITAMIN C			•
VITAMIN D	•
VITAMIN E	•
VORICONAZOLE	•			Avoid IV formulation in renal impairment; nephrotoxic vehicle
VORTIOXETINE	•
WARFARIN	•
XYLOMETAZOLINE				Route of elimination unknown
YOHIMBINE				Avoid. Route of elimination unknown
ZANAMIVIR	•
ZIDOVUDINE	•			Reduce dose in severe renal impairment
ZIPRASIDONE	•
ZOLEDRONIC ACID			•
ZOLMITRIPTAN	•			Active metabolite but no dosage adjustment required
ZOLPIDEM	•
ZOPICLONE	•
ZUCLOPENTHIXOL	•

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