| |
% Renal Elimination |
| |
< 50 % with active or toxic metabolites |
50 – 74 % |
> 75 % |
| A |
- Adefovir dipivoxil † (Nephrotoxic)
- Alendronate (Avoid in severe renal impairment)
- Allopurinol †
- Aluminum Salts (Avoid in severe renal impairment as may accumulate)
- Amphotericin B (Nephrotoxic)
- Apomorphine: The 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
- ASA
- Azathioprine †
|
- Acebutolol †
- Amiloride (Avoid in severe renal impairment)
- Amoxicillin
- Amoxicillin / Clavulanate
|
- Acamprosate (avoid in severe renal impairment)
- Acetazolamide (Avoid; ineffective when ClCr <10mL/min)
- Acyclovir
- Almotriptan
- Alogliptin (Active metabolites)
- Amantadine
- Amikacin (Nephrotoxic; monitor serum drug concentrations)
- Ampicillin
- Anakinra
- Atenolol
- Auranofin †
|
| B |
- Bictegravir ( Manufacturer recommends avoiding use if ClCr <30 mL/min)
- Bisacodyl ( Active metabolite but no dosage adjustment required)
- Bivaluridin (Reduce dose in severe renal impairment)
- Brexpiprazole (Manufacturer recommends reducing the dose by 25–33% when ClCr <60 mL/min)
- Bumetanide ( Larger doses may be required in severe renal impairment)
- Bupropion †
- Butalbital †
|
- Bezafibrate (Avoin in renal impairment)
- Bisoprolol
- Brinzolamide (Eye drops; contraindicated in severe renal impairment)
|
- Baclofen
- Baricitinib ( Manufacturer recommends avoiding use if ClCr <60 mL/min)
|
| C |
- Caffeine †
- Canagliflozin (Less effective in moderate and ineffective in severe renal impairment)
- Celecoxib (Nephrotoxic)
- Chloral Hydrate † (Avoid)
- Chlordiazepoxide †
- Cilazapril †
- Cladribine (Not recommended if ClCr <60 mL/min)
- Clarithromycin †
- Codeine †
- Colchicine (Avoid in renal impairment)
- Cyclophosphamide †
- Cyclosporine (Nephrotoxic; monitor serum drug concentrations)
|
- Captopril
- Cefixime
- Cefotaxime †
- Cefprozil
- Cetirizine
- Chloroquine
- Chlorthalidone (Avoid; ineffective when ClCr <30 mL/min)
- Cimetidine
- Ciprofloxacin
- Cyanocobalamine (% renal elimination increased with large doses)
|
- Cefadroxil
- Cefazolin
- Cefepime
- Cefoxitin
- Ceftazidime
- Cefuroxime
- Cephalexin
- Chromium
- Cidofovir †
- Clodronate (Avoid, Nephrotoxic)
|
| D |
- Dapagliflozin ( Contraindicated in moderate to severe renal impairment)
- Desloratadine †
- Desvenlafaxine (Manufacturer recommends dosage adjustment if ClCr <30 mL/min, although <50% renal elimination)
- Dexrazoxane (Reduce dose by 50% in patients with moderate to severe renal impairment)
- Dextromethorphan †
- Diclofenac (Nephrotoxic)
- Didanosine †
- Diflunisal (Nephrotoxic)
- Diphenoxylate (Active metabolites)
- Duloxetine (Use contraindicated by the manufacturer if ClCr <30 mL/min)
|
|
- Dabigatran ( Contraindicated in severe renal impairment)
- Dalteparin
- Daptomycin
- Deferoxamine
- Desmopressin
- Dicyclomine
- Digoxin (Monitor serum concentrations)
- Dofetilide
|
| E |
- Enalapril †
- Eplerenone ( Use contraindicated by the manufacturer if ClCr <30 mL/min)
- Eptifitabide ( Dosage adjustment recommended for patients with renal impairment)
- Esketamine †
- Ethacrynic Acid (Avoid in severe renal impairment)
- Etodolac (Nephrotoxic)
|
- Edoxaban
- Empagliflozin ( Less effective in moderate and ineffective in severe renal impairment)
- Ertugliflozin (Less effective in moderate, and ineffective in severe renal impairment)
- Ethambutol
- Etidronate (Nephrotoxic)
|
- Emtricitabine
- Enoxaparin
- Ertapenem
- Eslicarbazepine
- Eszopiclone
- Exenatide (Avoid in severe renal impairment)
|
| F |
- Famciclovir †
- Fenofibrate †
- Fexofenadine †
- Flecainide †
- Flurbiprofen (Nephrotoxic)
- Folic Acid (% renal elimination increased with large doses)
|
- Fesoterodine (Active metabolite)
- Fluconazole
- Furosemide ( Larger doses may be required in severe renal impairment)
|
- Famotidine
- Fampridine ( Use contraindicated by the manufacturer if ClCr <60 mL/min)
- Flucytosine
- Fondaparinux
- Foscarnet (Avoid, Nephrotoxic)
|
| G |
- Galantamine (Manufacturer recommends a maximum daily dose of 16 mg if ClCr <60 mL/min)
- Gemfibrozil †
- Glimepiride †
- Glyburide ( Avoid. Active metabolite but no dosage adjustment required)
|
|
- Gabapentin
- Ganciclovir
- Gentamicin ( Nephrotoxic; monitor serum drug concentrations)
|
| H |
- Hydrocodone †
- Hydroxychloroquine †
|
|
- HCTZ (Avoid; ineffective when ClCr <30 mL/min)
|
| I |
- Ibuprofen (Nephrotoxic)
- Indapamide (Avoid; ineffective when ClCr <30 mL/min)
- Indomethacin (Nephrotoxic)
- Isotretinoin (Avoid in renal impairment)
|
|
|
| K |
|
|
|
| L |
- Leflunomide †
- Loratadine ( Active metabolite; consider dosage adjustment in severe renal impairment)
- Lurasidone †
|
Lamivudine †
|
- L-Carnitine
- Lacosamide (Manufacturer recommends a maximum daily dose of 300 mg in patients with end-stage renal disease)
- Levofloxacin
- Lisinopril
- Lithium (Nephrotoxic; monitor serum drug concentrations)
|
| |
Levetiracetam
IR and IV formulations (Ref):
CrCl 80 to 130 mL/minute/1.73 m2: 500 mg to 1.5 g every 12 hours.
CrCl 50 to <80 mL/minute/1.73 m2: 500 mg to 1 g every 12 hours.
CrCl 30 to <50 mL/minute/1.73 m2: 250 to 750 mg every 12 hours.
CrCl 15 to <30 mL/minute/1.73 m2: 250 to 500 mg every 12 hours.
CrCl <15 mL/minute/1.73 m2: 250 to 500 mg every 24 hours (Ref).
ER tablet:
CrCl >80 mL/minute/1.73 m2: 1 to 3 g every 24 hours.
CrCl 50 to 80 mL/minute/1.73 m2: 1 to 2 g every 24 hours.
CrCl 30 to 50 mL/minute/1.73 m2: 500 mg to 1.5 g every 24 hours.
CrCl <30 mL/minute/1.73 m2: 500 mg to 1 g every 24 hours.
|
|
| |
levomilnacipran |
|
| M |
- Magnesium salts (Avoid in severe renal impairment as may accumulate)
- Maraviroc (Modify dose when taking concurrent potent CYP3A4 inhibitors)
- Mefenamic Acid (Nephrotoxic)
- Meloxicam (Nephrotoxic)
- Meperidine †
- Mercaptopurine †
- Methazolamide (Avoid; ineffective in severe renal impairment)
- Methyldopa †
- Midodrine †
- Mirabegron (Manufacturer recommends a maximum daily dose of 25 mg in patients with severe renal impairment)
- Morphine †
|
- Meropenem
- Methylnaltrexone
|
- Memantine
- MESNA
- Metformin (Avoid in severe renal impairment)
- Methotrexate (Avoid, Nephrotoxic)
- Metoclopramide †
- Milrinone
- Mirtazapine
|
| N |
- Nabumetone † (Nephrotoxic)
- Naloxegol (Manufacturer recommends 50% reduction of initial dose in moderate or severe renal impairment)
- Naproxen (Nephrotoxic)
- Nebivolol †
- Nitrofurantoin (Avoid in renal impairment)
|
|
- Nadolol
- Nadroparin
- Norfloxacin
|
| O |
- Octreotide (Reduce dose in severe renal impairment)
- Olmesartan (Not recommended in severe renal impairment)
- Orphenadrine †
- Oseltamivir (dosage adjustment recommended in severe renal impairment)
- Oxcarbazepine †
|
|
|
| P |
- Penicillamine (Avoid, Nephrotoxic)
- Pentamidine (Nephrotoxic when given IV)
- Perindopril †
- Piroxicam (Nephrotoxic)
- Prochlorperazine †
- Procyclidine †
- Pyrazinamide (Avoid in severe renal impairment)
|
- Paliperidone (Manufacturer recommends dosage adjustment in renal impairment)
- Pamidronate (Nephrotoxic)
- Penicillin G/V
- Procainamide †
- Prucalopride
- Pyridoxine (% renal elimination increased with large doses)
|
- Pheniramine
- Piperacillin
- Piperacillin/tazobactam
- Potassium salts (May accumulate in renal impairment)
- Pramipexole
- Pregabalin
- Probenecid (Ineffective when ClCr <50 mL/min)
- Pseudoephedrine
|
| Q |
|
|
|
| R |
- Ramipril †
- Remdesevir (Active metabolite. The excipient betadex sulfobutyl ether may accumulate in severe renal impairment)
- Ribavirin (Avoid in renal impairment)
- Risperidone †
- Rituximab (Nephrotoxic)
- Rivaroxaban (Avoid in severe renal impairment)
|
|
- Risedronate (Avoid in severe renal impairment)
|
| S |
- Saxagliptin †
- Spironolactone † (Avoid)
- Stavudine †
- Sulfinpyrazone (Avoid, Nephrotoxic)
- Sulindac (Nephrotoxic)
|
- Sacubitril/valsartan
- Solifenacin (Active metabolites)
- Sotalol
- Sulfadiazine (Nephrotoxic)
- SMZ/TMP
|
- Sitagliptin
- Streptomycin (Nephrotoxic; monitor serum drug concentrations)
|
| T |
- Tadalafil †
- Tapentadol (Not recommended in severe renal impairment)
- Tenoxicam (Nephrotoxic)
- Teriparatide (Do not use if ClCr <30 mL/min)
- Tofacitinib (Manufacturer recommends dosage adjustment in moderate or severe renal impairment)
- Tramadol †
- Trandolapril †
- Tranylcypromine †
- Triamterene (Avoid; nephrotoxic. Active metabolite but no dosage adjustment required)
|
- Terbinafine
- Tetracycline (Nephrotoxic)
- Tirofiban
|
- Telbivudine
- Tenofovir (Nephrotoxic)
- Tiaprofenic Acid (Nephrotoxic)
- Tinzaparin
- Tobramycin (Nephrotoxic)
- Topiramate
- Tranexamic Acid
- Trihexyphenidyl
- Trimethoprim
|
| V |
- Valacyclovir †
- Venlafaxine †
- Voriconazole (Avoid IV formulations in renal impairment; nephrotoxic vehicle)
|
- Valganciclovir † (Nephrotoxic)
|
- Vancomycin (Nephrotoxic; monitor serum drug concentrations)
- Varenicline
- Vigabatrin
- Vitamin C
|
| Z |
- Zidovudine (Reduce dose in severe renal impairment)
|
|
|
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