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Drugs in Renal Disease - An Expert?

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  • Drugs in Renal Disease - An Expert?

    Hey ppl

    I’ve always found this topic tricky…but really interesting.

    A very good source would be the ‘Renal Drug Handbook’, but not everyone keeps this book.

    I understand that in renal impairment you have reduced drug clearance and in some cases dose adjustments are needed.

    Patients may be on narrow therapeutic range drugs (digoxin, lithium etc), nephrotoxic drugs (frusemide, gentamicin etc) or may be having dialysis.

    How are these managed in the community?

    Does anyone have anything interesting they’ve come across???

    Or any good sources to read???

    Any suggestions please???

    Lazy Lady...
    [IMG]http://www.polyvore.com/cgi/img-set?.out=jpg&id=VgnFNpwK3hGyUXFqqJvo3g&size=l[/IMG]

  • #2
    Re: Drugs in Renal Disease - An Expert?

    This paper from bmj assessing the quality of the 4 major resources for dosing in renal impairment: Systematic comparison of four sources of drug information regarding adjustment of dose for renal function -- Vidal et al. 331 (7511): 263 -- BMJ

    Best online help: Renal Dosing Database - Index (home) Page

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    • #3
      Re: Drugs in Renal Disease - An Expert?

      Thank you Shwampa

      A very useful link…it’s given me a good insight. I guess for adults there is plenty of information out there, but for children hardly anything.

      It must be tricky in community, as you don’t have the relevant tests ‘creatinine and urea’.

      ….it seems ‘Drugs in renal disease’ is not a hot topic on the forum.

      I got one case study here:

      Mr GS has ‘moderate renal impairment’. He is fairly active man, non-smoker, and weighs 85 kg.

      Vancomycin 2g OD
      Frusemide 80mg BD
      Tazocin 2g QDS
      Ramipril 5mg OD

      What changes would people make? What do you think?
      Lazy Lady...
      [IMG]http://www.polyvore.com/cgi/img-set?.out=jpg&id=VgnFNpwK3hGyUXFqqJvo3g&size=l[/IMG]

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      • #4
        Re: Drugs in Renal Disease - An Expert?

        Moderate impaired renal function is per definition (CrCl = 10 to 20 ml/min).

        There're different guidelines about vanco dosing, but for sure you need to reduce the dose. Have a look at http://www.glasgowformulary.scot.nhs...une%202008.pdf

        Cocommitant use of fuorsemide and vancomycine increases the risk of ototoxicity: either suspend furosemide, or reduce dose and monitor hearing function.

        Tazocin need dosage adjustment in renal impairment.

        Ramipril dose is high as well http://www.nps.org.au/__data/assets/...R_ramipril.pdf

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        • #5
          Re: Drugs in Renal Disease - An Expert?

          Originally posted by Lazy Nite View Post
          How are these managed in the community?
          The ostrich system is used.
          No one mentions renal impairment and we don't go looking for it.
          Then everyone is happy.

          Jeff

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          • #6
            Re: Drugs in Renal Disease - An Expert?

            It would be good if there was some kind of expert help line that could be used by pharmacists and other healthcare professionals for renal problems. I've had a few situations where I've been desperately scouring the internet for "relative risks" for certain drug regimes with patients with severe renal impairment.

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            • #7
              Re: Drugs in Renal Disease - An Expert?

              Originally posted by Raju View Post
              It would be good if there was some kind of expert help line that could be used by pharmacists and other healthcare professionals for renal problems. I've had a few situations where I've been desperately scouring the internet for "relative risks" for certain drug regimes with patients with severe renal impairment.
              Medicines Information Services numbers listed in the BNF

              or

              http://www.swmit.nhs.uk/Renal.htm


              Jeff
              Last edited by Jeff; 12, December 2008, 01:59 PM.

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