Drugs that require dose reduction in CKD
Most drugs are removed from the body by the kidneys. This means the blood levels of these drugs can build up in CKD, possibly making them toxic. Hence some drugs require dose reduction in CKD, and others should be avoided.
Drugs to avoid in CKD
- Some antibiotics: tetracycline
- Long-term aspirin (and NSAIDs)
- Lithium. No not stop unless agreed by psychiatrist and patient
- Metformin. Should be stopped when GFR reaches 30 ml/min
- Chinese herbal medicines.
Note. If the patient is already on one of these, do not necessarily stop them without thought. There may be advantages to the patient to stay on them, and that can happen with does reduction.
Drugs likely to accumulate in chronic kidney disease – usually need dose reduction
- Enoxaparin (and other LMW heparins)
- Some antibiotics including vancomycin, gentamicin and streptomycin
- Digoxin
- Methotrexate
- Sulphonylureas
- Opioids.
Drugs that are relatively safe – and don’t usually need dose adjustment
- Some antibiotics: erythromycin and rifampicin
- Diazepam (and benzodiazepines)
- Warfarin
- Apixaban (and DOACs).
Last Reviewed on 19 April 2024