- Be very careful when prescribing any medicine and check available prescribing information (e.g. in Practical
Guidelines for Dispensing 2015) regarding use in renal failure/impairment - Many medicines are excreted through the kidneys and accumulate when urinary output is reduced
- Some drugs are presented as sodium or potassium salts and contribute to accumulation of these electrolytes
- With life-threatening infections (e.g. meningitis), use normal or high doses of antibiotics initially, and then
reduce doses once the condition has responded
Drugs which are usually safe
- Doxycycline
- Erythromycin
- Benzylpenicillin (max 6 g daily in severe impairment)
- Phenytoin
- Rifampicin
Drugs to use with care in reduced doses
- ACE inhibitors (e.g. captopril)
- Amoxicillin
- Chloramphenicol (avoid in severe impairment)
- Ciprofloxacin
- Cotrimoxazole
- Diazepam
- Digoxin
- Insulin
- Isoniazid-containing medicines
- Pethidine (increase dose interval, avoid in severe impairment)
- Phenobarbital
- Propranolol
Drugs to avoid using
- Acetylsalicylic acid (aspirin) and other NSAIDS e.g. ibuprofen, indomethacin
- Codeine
- Ethambutol
- Gentamicin
- Metformin
- Nalidixic acid
- Nitrofurantoin
- Streptomycin
- Tenofovir (TDF)