Skip to main content
SpringerLink
Log in

Drug Dosage in Renal Disease

  • Published:
Clinical Pharmacokinetics Aims and scope Submit manuscript

Summary

Based on the well known linear relationship between the overall drug elimination rate constant and the endogenous creatinine clearance, it is shown how individual drug elimination parameters in patients with renal disease can be estimated from the patient’s creatinine clearance or serum creatinine concentration.

By means of a simple nomogram the elimination rate fraction is determined which describes the elimination rate of the drug as a fraction of its normal elimination rate constant. Based on the estimated elimination rate fraction the dosage regimen in the patient with renal disease is individually modified according to pharmacokinetic principles. At present the described method can be used with 45 different drugs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Baethke, R.; Golde, G. and Gahl, G.: Sulphamethoxazoletrimethoprim: pharmacokinetic studies in patients with chronic renal failure. European Journal of Clinical Pharmacology 4: 233–240 (1972).

    Article  Google Scholar 

  • Bennett, W.M.; Singer, I. and Coggins, C.H.: A practical guide to drug usage in adult patients with impaired renal function. Journal of the American Medical Association 214: 1468–1475 (1970).

    Article  PubMed  CAS  Google Scholar 

  • Bricker, N.S.; Morrin, P.A.F. and Kime, S.W.: The pathologic physiology of chronic Bright’s disease. American Journal of Medicine 28: 77–98 (1960).

    Article  PubMed  CAS  Google Scholar 

  • Bulger, R.J. and Petersdorf, R.G.: Antimicrobial therapy in patients with renal impairment. Journal of Postgraduate Medicine 47: 160–165 (1970).

    CAS  Google Scholar 

  • Chiou, W.L. and Hsu, F.H.: A new simple and rapid method to monitor the renal function based on pharmacokinetic consideration of endogenous creatinine. Research Communications in Chemical Pathology and Pharmacology 10: 315–330 (1975).

    PubMed  CAS  Google Scholar 

  • Cutler, R.E. and Orme, B.M.: Correlation of serum creatinine concentration and kanamycin half-life. Journal of the American Medical Association 209: 539–542 (1969).

    Article  PubMed  CAS  Google Scholar 

  • Dettli, L.: Individualization of drug dosage in patients with renal disease. Medical Clinics of North America 58: 977–985 (1974).

    PubMed  CAS  Google Scholar 

  • Dettli, L.: Drug dosage in renal disease. Clinical Pharmacology and Therapeutics 16: 274–280 (1974a).

    PubMed  CAS  Google Scholar 

  • Dettli, L.: Calculation of dosage regimens in patients with renal disease based on incomplete pharmacokinetic data. International Symposium on Clinical Pharmacy and Clinical Pharmacology, Boston. In press (1975).

    Google Scholar 

  • Dettli, L. and Spring, P.: The modifying effects of physiological variables and disease upon pharmacokinetics. Proceedings of the 5th International Congress on Pharmacology 3: 165–173 (1973).

    CAS  Google Scholar 

  • Dettli, L.; Spring, P. and Habersang, R.: Drug dosage in patients with impaired renal function. Postgraduate Medical Journal 46 (Suppl.): 32–35 (1970).

    Article  Google Scholar 

  • Dettli, L.; Spring, P. and Ryter, S.: Multiple dose kinetics and drug dosage in patients with kidney disease. Acta Pharmacologica et Toxicologica Scandinavica 29 (Suppl. 3): 211–224 (1971).

    CAS  Google Scholar 

  • Fabre, J.: Comment prescrire les médicaments en présence de fonctions rénales déficientes? Schweizerische Medizinische Wochenschrift 102: 251–256 (1972).

    PubMed  CAS  Google Scholar 

  • Gibaldi, M. and Perrier, D.: Drug elimination and apparent volume of distribution in multicompartment systems. Journal of Pharmacuetical Sciences 61: 952–954 (1972).

    Article  CAS  Google Scholar 

  • Jackson, E.A. and McLeod, D.C.: Pharmacokinetics and dosing of antimicrobial agents in renal impairment. American Journal of Hospital Pharmacy 31: 36–52 (1974).

    PubMed  CAS  Google Scholar 

  • Jelliffe, R.W. and Jelliffe, S.M.: A computer program for estimation of creatinine clearance from unstable serum creatinine levels, age, sex, and weight. Mathematical Biosciences 14: 17–24 (1972).

    Article  Google Scholar 

  • Koup, J.R.; Jusko, W.J.; Elwood, Ch.M. and Kohli, R.K.: Digoxin pharmacokinetics: Role of renal failure in dosage regimen design. Clinical Pharmacology and Therapeutics 18: 9–21 (1975).

    PubMed  CAS  Google Scholar 

  • Krueger-Thiemer, E.: Dosage schedule and pharmacokinetics in chemotherapy. Journal of the American Pharmaceutical Association (Scientific Edition) 49: 311–313 (1960).

    Article  CAS  Google Scholar 

  • Kunin, C.M.: A guide to use antibiotics in patients with renal disease. Annals of Internal Medicine 67: 151–158 (1967).

    PubMed  CAS  Google Scholar 

  • Oe, P.L.: Antimicrobial therapy and renal failure (Beecham Research Laboratories, Amsterdam 1974).

    Google Scholar 

  • O’Malley, K.; Velasco, M.; Pruitt, A. and McNay, J.L.: Decreased plasma protein binding of diazoxide in uremia. Clinical Pharmacology and Therapeutics 18: 53–58 (1975).

    PubMed  Google Scholar 

  • Reidenberg, M.M.: Renal function and drug action (Saunders, Philadelphia 1971).

    Google Scholar 

  • Reidenberg, M.M.; Odar-Cederlös, I.; von Bahr, C.; Borga, O. and Sjöqvist, F.: Protein binding of diphenylhydantoin and desmethylimipramine in plasma from patients with poor renal function. New England Journal of Medicine 285: 264–267 (1971).

    Article  PubMed  CAS  Google Scholar 

  • Siersback-Nielsen, K.; Molholm Hansen, J.; Kampmann, J. and Kristensen, M.: Rapid evaluation of creatinine clearance. Lancet 2: 1133–1134 (1971).

    Article  Google Scholar 

  • Spring, P.: Simple ‘rules of thumb’ for the dosage adjustment of gentamicin and cephalosporins in patients with renal disease. Proceedings of the 8th International Congress of Chemotherapy 2: 773–775 (The Hellenic Society for Chemotherapy, Athens 1974).

    Google Scholar 

  • Spring, P.: Calculation of drug dosage regimens in patients with renal disease: A new nomographic method. International Journal of Clinical Pharmacology and Biopharmacy 11: 76–80 (1975).

    PubMed  CAS  Google Scholar 

  • Tozer, Th.N.: Nomogram for modification of dosage regimens in patients with chronic renal impairment. Journal of Pharmacokinetics and Biopharmaceutics 2: 13–28 (1974).

    Article  Google Scholar 

  • Wagner, J.G.: Biopharmaceutics and relevant pharmacokinetics (Hamilton Press, Hamilton 1971).

    Google Scholar 

  • Wagner, J.G.: Relevant pharmacokinetics of antimicrobial drugs. Medical Clinics of North America 58: 479–492 (1974).

    PubMed  CAS  Google Scholar 

  • Welling, P.G.; Craig, W.A.; Amidon, G.L. and Kunin, C.M.: Pharmacokinetics of cefazolin in normal and uremic subjects. Clinical Pharmacology and Therapeutics 15: 344–353 (1973).

    Google Scholar 

  • Welling, P.G.; Craig, W.A. and Kunin, C.M.: Prediction of drug dosage in patients with renal failure using data derived from normal subjects. Clinical Pharmacology and Therapeutics 18: 45–52 (1975).

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Basel, Basel

    L. Dettli

Authors
  1. L. Dettli
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dettli, L. Drug Dosage in Renal Disease. Clin Pharmacokinet 1, 126–134 (1976). https://doi.org/10.2165/00003088-197601020-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003088-197601020-00004

Keywords

Search

Navigation