Medication Adjustment

Renal dosing guidelines and drug-drug interaction checker.

AI Drug Assistant

Ask about renal dosing, interactions, or side effects

Common Renal Adjustments

MetforminStop if GFR < 30

Reduce dose by 50% if GFR 30-45. Risk of lactic acidosis.

Apixaban (Eliquis)2.5mg BID if...

If 2 of 3: Age ≥ 80, Wt ≤ 60kg, Cr ≥ 1.5. Safe in ESRD (per guidelines).

Rivaroxaban (Xarelto)Avoid if GFR < 15

Dose 15mg QD if GFR 15-50.

SpironolactoneCaution GFR < 30

High risk of hyperkalemia. Monitor K+ closely.

AllopurinolReduce Dose

Start 50-100mg QD if GFR < 30 to avoid hypersensitivity.

GabapentinRenal Dosed

GFR < 15: 300mg QOD or 100-300mg post-HD.

Antibiotics in Dialysis

Post-HD dosing for common agents

VancomycinLoad 20-25mg/kg, then 500mg-1g post-HD (Target trough)

Cefepime1g IV post-HD (Risk of neurotoxicity)

Meropenem500mg - 1g IV post-HD

Pip-Tazo (Zosyn)2.25g IV q8h or 3.375g post-HD (Variable)

Ciprofloxacin250-500mg PO/IV q12-24h

Disclaimer

AI responses are for educational purposes only. Always verify with official pharmacy resources (Lexicomp, Micromedex).

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