1. Raniah Al-Jaizani M.Sc Lecturer, Clinical Pharmacy Dept.
Dosing of drugs in Renal failure
Raniah Al-Jaizani M.Sc
Lecturer, Clinical Pharmacy Dept.

2. Dosing of drugs in Renal failure
CASE 1
G.G., a 31 y.o, woman IBW 70 kg with 3 yr hx of SLE, present to ER with 3 days hx of fatigue, weakness, nausea, and fever. Laboratory value: Na= 142 mEq/L ( ) Srcr= 3.4 mg/dl ( ) BUN= 38 mg/dl (7-20) Two weeks into her hospital course, G.G’s condition worse and she develops sings of sepsis. Pseudomonas aeruginosa is cultured from her urine. Therapy with ceftazidime (1g every 24 hr) was initiated. G.G’s medical team decide that the addition of an aminoglycoside is now necessary. How should the gentamicin be dosed in G.G?

3. Dosing of drugs in Renal failure
Case 1 (Answer)
Normal dose in sever life-theratening infections: mg/ kg/dose
90-97 % excreted renally
Clcr= 26.7 ml/min
Clcr ml/min: 100% of normal dose administered every 24 hr
So, G.G dose of gentamicin 140 q 24 hr
Peak and trough level should be monitored

4. Dosing of drugs in Renal failure
CASE 2
D.M, a 28 y.o, 50 kg man with AIDS present with sever herpetic infection requiring I.V acyclovir. Due to other complication associated with his HIV virus, D.M has developed renal insufficiency during his hospital course. His Srcr= 4.5 mg/dl ( ) How should acyclovair be dosed in D.M?

5. Dosing of drugs in Renal failure
Case 2 (Answer)
Normal dose=10 mg/kg intravenously over 1 hour, every 8 hours
76-82 % excreted renally
Clcr= ml/min
Clcr ml/min: 5-10 mg/kg/dose administered every 24 hr
So, D.M acyclovair I.V dose 500 mg I.V infused over 1 hour q 24 hours

6. Dosing of drugs in Renal failure
CASE 3
Huda is medical intern in KKUH call drug information center asking you some question about vancomycin.
What is the normal dose of vancomycin?
Should vancomycin dose adjusted in renal failure patients?
K.A, is 55 y.o female, 80 kg, with MRSA and vancomycin
should be initiated what is the dose of vancomycin if her Srcr=
2 mg/dl ( )

7. Dosing of drugs in Renal failure
Case 3 (Answer)
Normal dose= 1 g every 12 hr
Yes, % excreted renally
Clcr= 40 ml/min
Clcr ml/min: start with 1g or mg/kg/dose every 24 hr
So, K.A dose of vancomycin 1 g I.V infused over 2 hours q 24 hr
Peak and trough level should be monitored