Clinical Pharmacokinetics

, Volume 11, Issue 2, pp 164–170 | Cite as

Nomogram for Drug Dosage Adjustment in Patients with Renal Failure

  • Thorir D. Bjornsson
Original Research Article

Summary

A nomogram is presented for the rapid determination of the dosage adjustment factor for drugs eliminated in part by the kidneys in patients with reduced renal function. This nomogram method is based on knowledge of the fraction of a dose of the drug of interest eliminated by the kidneys in subjects with normal renal function and an estimation of the renal function of the patient in question. It assumes that there is no reduction in the liver metabolism of the drug in patients with reduced renal function. The dosage adjustment factor thus derived can be used to change the dosage regimen of the drug in patients with reduced renal function.

Keywords

Creatinine Clearance Normal Renal Function Colistin Serum Creatinine Concentration Cefonicid 

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References

  1. Anderson RJ, Gambertoglio JG, Schrier RW. Clinical use of drugs in renal failure. Chaires C. Thomas, Springfield, 1976Google Scholar
  2. Benet LZ, Sheiner LB. Design and optimization of dosage regimens; pharmacokinetic data. In Gilman et al. (Eds) The pharmacological basis of therapeutics, pp. 286–325, Macmillan, New York, 1980Google Scholar
  3. Bennett WM, Muther RS, Parker RA, Feig P, Morrison G, et al. Drug therapy in renal failure: dosing guidelines for adults. Annals of Internal Medicine 93: 62–89, 1980PubMedGoogle Scholar
  4. Bennett WM, Muther RS, Parker RA, Feig P, Morrison G, et al. Drug therapy in renal failure: Part II: Sedatives, hypnotics, and tranquilizers; cardiovascular antihypertensives, and diuretic agents; miscellaneous agents. Annals of Internal Medicine 93: 286–325, 1980bPubMedGoogle Scholar
  5. Bjornsson TD. Use of serum creatinine concentrations to determine renal function. Clinical Pharmacokinetics 4: 200–222, 1979PubMedCrossRefGoogle Scholar
  6. Bjornsson TD, Shand DG. Estimation of kinetic parameters of drugs based on the drug cumulation factor. Clinical Pharmacology and Therapeutics 26: 540–547, 1979PubMedGoogle Scholar
  7. Bjornsson TD, Cocchetto DM, McGowan FX, Verghese CP, Sedor F. Nomogram for estimating creatinine clearance. Clinical Pharmacokinetics 8: 365–369, 1983PubMedCrossRefGoogle Scholar
  8. Blaschke TF, Rubin PC. Hepatic first-pass metabolism in liver disease. Clinical Pharmacokinetics 4: 423–432, 1979PubMedCrossRefGoogle Scholar
  9. Bochner F, Carruthers, G, Kampmann J, Steiner J. Handbook of clinical pharmacology, Little, Brown & Cobb, Boston, 1983Google Scholar
  10. Brater DC. Drug use in renal disease, ADIS Health Science Press, Boston, 1983Google Scholar
  11. Chennavasin P, Brater DC. Nomograms for drug use in renal disease. Clinical Pharmacokinetics 6: 193–214, 1981PubMedCrossRefGoogle Scholar
  12. Cocchetto DM, Tschanz C, Bjornsson TD. Decreased rate of creatinine production in patients with hepatic disease. Implications for estimation of creatinine clearance. Therapeutic Drug Monitoring 5: 161–168, 1983PubMedCrossRefGoogle Scholar
  13. Cockcroft CW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 16: 31–41, 1976PubMedCrossRefGoogle Scholar
  14. Dettli L. Drug dosage in renal failure. Clinical Pharmacokinetics 1: 126–134, 1976PubMedCrossRefGoogle Scholar
  15. Dettli L. Drug dosage in renal failure. In Gibaldi & Prescott (Eds) Handbook of clinical pharmacokinetics, pp. 261–276, ADIS Health Science Press, New York, 1983Google Scholar
  16. Gambertoglio JG. Effects of renal disease: altered pharmacokinetics. In Benet et al. (Eds) Pharmacokinetic basis for drug treatment, pp. 147–171, Raven Press, New York, 1984Google Scholar
  17. Gibaldi M, Perrier D. Pharmacokinetics, 2nd ed., pp. 113–144, 385-407, Marcel Dekker, New York, 1983Google Scholar
  18. Hallynck T, Soep HH, Thomis J, Boelaert J, Daneeis R, et al. Prediction of creatinine clearance from serum creatinine concentrations based on lean body mass. Clinical Pharmacology and Therapeutics 30: 414–421, 1981PubMedCrossRefGoogle Scholar
  19. Kampmann J, Siersbaek-Nielsen K, Kristensen M, Hansen JM. Rapid evaluation of creatinine clearance. Acta Medica Scandinavica 196: 517–520, 1974PubMedCrossRefGoogle Scholar
  20. Knoben JE, Anderson PO. Handbook of clinical drug data, Drug Intelligence Publications, Hamilton, Ill., 1983Google Scholar
  21. Levy G. Pharmacokinetics in renal disease. American Journal of Medicine 62: 461–465, 1977PubMedCrossRefGoogle Scholar
  22. Rowland M, Tozer TN. Clinical pharmacokinetics: concepts and applications, pp. 230–245, Lea and Febiger, Philadelphia, 1980Google Scholar
  23. Tozer TN. Nomogram for modification of dosage regimen in patients with chronic renal function impairment. Journal of Pharmacokinetics and Biopharmaceutics 2: 13–28, 1974Google Scholar

Copyright information

© ADIS Press Limited 1986

Authors and Affiliations

  • Thorir D. Bjornsson
    • 1
  1. 1.Division of Clinical Pharmacology, Departments of Medicine and PharmacologyDuke University Medical CenterDurhamUSA

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