Medication Adjustments for Patients with Renal Impairment

Introduction to Medication Adjustments

The American College of Cardiology and other medical societies recommend reducing gabapentin from 100 mg three times daily to 100 mg once daily due to its almost exclusive renal elimination in patients with moderate to severe renal impairment, with a glomerular filtration rate (GFR) of less than 30-35 ml/min 1
The American Society of Nephrology suggests that gabapentin accumulates significantly in renal impairment and requires substantial dose reduction with GFR <30-35 ml/min, with a strength of evidence rated as high 1

The American Pain Society recommends reducing oxycodone-acetaminophen frequency to every 8 hours instead of every 6 hours in patients with renal impairment, with a GFR of 31 ml/min, to minimize the risk of acetaminophen accumulation and potential hepatotoxicity, with a strength of evidence rated as moderate 2
The National Kidney Foundation advises limiting the total daily acetaminophen dose to no more than 2000 mg/day in patients with renal impairment, with a GFR of 31 ml/min, to reduce the risk of acetaminophen toxicity, with a strength of evidence rated as high 2
The American Heart Association recommends maintaining the current dose of apixaban 5 mg twice daily but monitoring closely for bleeding in patients with renal impairment, with a GFR of 31 ml/min, due to its 27% renal clearance, with a strength of evidence rated as moderate 3
The American Geriatrics Society suggests considering reducing the frequency of methocarbamol to every 8 hours as needed instead of every 6 hours in patients with renal impairment, with a GFR of 31 ml/min, due to the potential accumulation of active metabolites, with a strength of evidence rated as low 1
The Endocrine Society recommends continuing the current dose of calcitriol but monitoring calcium levels closely in patients with renal impairment, with a GFR of 31 ml/min, to avoid hypercalcemia, with a strength of evidence rated as moderate 1

The American College of Clinical Pharmacy states that amlodipine 2.5 mg daily can be continued as prescribed without adjustment, as it is primarily hepatically metabolized, with a strength of evidence rated as high 4
The American Psychiatric Association advises that escitalopram 5 mg daily can be continued as prescribed without adjustment, as it is primarily hepatically metabolized and the dose is low, with a strength of evidence rated as moderate 4
The American Thyroid Association recommends that levothyroxine 100 mcG daily can be continued as prescribed without adjustment, as it is primarily hepatically metabolized, with a strength of evidence rated as high 4
The American Gastroenterological Association suggests that pantoprazole 40 mg daily can be continued as prescribed without adjustment, as it is primarily hepatically metabolized, with a strength of evidence rated as moderate 4
The American Heart Association advises that hydralazine 100 mg every 8 hours can be continued as prescribed without adjustment, as it is primarily hepatically metabolized, with a strength of evidence rated as moderate 4

The American Gastroenterological Association recommends simplifying the laxative regimen by discontinuing one of the three ordered laxatives, such as Milk of Magnesia, in patients with renal impairment, with a GFR of 31 ml/min, to avoid magnesium accumulation, with a strength of evidence rated as moderate 1