• 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)