Madison Clinic
For Providers For Patients Pharmacy Calendar Resources

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:

  1. Dosing information taken from manufacturer prescribing information
  2. 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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