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Renal Insufficiency - Dose Adjustments

Various antiretroviral drugs are excreted primarily through the kidney and must be dose adjusted in the setting of renal insufficiency or hemodialysis.

Dosage recommendations for antiretroviral drugs in renal insufficiency
Renal function (mL/min)	CrCl > 50	CrCl 30-49	CrCl 10-29	CrCl < 10
NRTI/Nucleotides
zidovudine	300mg BID	300mg BID	300mg BID	100mg Q8H*
didanosine EC
BW³ 60kg	400mg QD	200mg QD	125mg QD	125mg QD
BW <60kg	250mg QD	125mg QD	125mg QD	Do not use EC
zalcitabine	0.75mg TID	0.75mg BID	0.75mg BID	0.75mg QD
stavudine
BW³ 60kg	40mg BID	20mg BID	20mg QD	20mg QD
BW <60kg	30mg BID	15mg BID	15mg QD	15mg QD
lamivudine	300mg QD	150mg QD	100mg QD	25-50mg QD**
emtricitibine	200mg QD	200mg Q48h	200mg Q72h***	200mg Q96h****
abacavir	300mg BID	300mg BID	300mg BID	300mg BID
tenofovir	300mg QD	300mg Q48h	300mg Q72-96h	300mg Q72h
NNRTIs
nevirapine	200mg BID	Standard	Standard	Standard
delavirdine	600mg BID	Standard	Standard	Standard
efavirenz	600mg QHS	Standard	Standard	Standard
Protease Inhibitors
saquinavir	1200mg TID	Standard	Standard	Standard
ritonavir	600mg BID	Standard	Standard	Standard
indinavir	800mg Q8h	Standard	Standard	Standard
nelfinavir	1250mg BID	Standard	Standard	Standard
fosamprenavir	1400mg BID	Standard	Standard	Standard
lopinavir/r	400mg BID	Standard	Standard	Standard
atazanavir	400mg QD	Standard	Standard	Standard
tipranavir	500mg BID	Standard	Standard	Standard

BID = every 12 hours; QD = every 24 hours
* Definitive dosing of AZT has not been established
**Manufacturer suggests a loading dose of 150mg (x1) when CrCl < 30 mL/min; doses
up to 150mg QD in end stage renal disease were demonstrated safe and tolerable. 2
***CrCl 15-29
****CrCl < 15

References:

Dosing information taken from manufacturer prescribing information
Steady-state pharmacokinetics of lamivudine in human immunodeficiency virus-infected patients with end-stage renal disease receiving chronic dialysis.
Antimicrob Agents Chemother 2002 Aug; 46(8):2387-92

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Renal Insufficiency - Dose Adjustments

Dosage recommendations for antiretroviral drugs in renal insufficiency

NRTI/Nucleotides

NNRTIs

Protease Inhibitors