Molsidomine Use in Renal Impairment

Clinical Considerations

A lower starting dose of molsidomine may be recommended in certain patients with impaired kidney function, as advised by the American Journal of Kidney Diseases 1

Opioids such as meperidine, codeine, and morphine should be avoided in renal insufficiency (GFR <30 mL/min/1.73 m²) due to active metabolites and accumulation, as recommended by the Mayo Clinic Proceedings 2
Tramadol and tapentadol are not recommended in renal insufficiency (GFR <30 mL/min/1.73 m²), according to the Mayo Clinic Proceedings 2
Many antihistamines require dose adjustments in renal impairment - cetirizine and levocetirizine doses should be halved, while some are contraindicated in severe renal impairment, as stated by the British Journal of Dermatology 3
Factor Xa inhibitors like fondaparinux are contraindicated in severe renal insufficiency (CCr <30 mL/min), as recommended by the Journal of the National Comprehensive Cancer Network 4, 5