Data currently are not available for patients receiving peritoneal dialysis. Until data
become available, begin with doses recommended for patients receiving hemodialysis and verify
adequacy of dosing using serum concentration monitoring.
Usual Dose (UD) Normal Renal Function
600 mg/day
CrCl 30-90
UD
CrCl <30 or Hemodialysis
UD
Peritoneal Dialysis
Data currently are not available for patients receiving peritoneal dialysis. Until data
become available, begin with doses recommended for patients receiving hemodialysis and verify
adequacy of dosing using serum concentration monitoring.
Usual Dose (UD) Normal Renal Function
15-25 mg/kg/day
CrCl 30-90
UD
CrCl <30 or Hemodialysis
20-25 mg/kg/dose thrice weekly
Peritoneal Dialysis
Data currently are not available for patients receiving peritoneal dialysis. Until data
become available, begin with doses recommended for patients receiving hemodialysis and verify
adequacy of dosing using serum concentration monitoring.
Usual Dose (UD) Normal Renal Function
25 mg/kg/ day (max 2 gm/day)
CrCl 30-90
UD
CrCl <30 or Hemodialysis
25-35 mg/kg/dose thrice weekly
Peritoneal Dialysis
Data currently are not available for patients receiving peritoneal dialysis. Until data
become available, begin with doses recommended for patients receiving hemodialysis and verify
adequacy of dosing using serum concentration monitoring.
Usual Dose (UD) Normal Renal Function
750 mg/day
CrCl 30-90
UD
CrCl <30 or Hemodialysis
750-1000 mg/dose thrice weekly
Peritoneal Dialysis
Data currently are not available for patients receiving peritoneal dialysis. Until data
become available, begin with doses recommended for patients receiving hemodialysis and verify
adequacy of dosing using serum concentration monitoring.
Usual Dose (UD) Normal Renal Function
400 mg/day
CrCl 30-90
UD
CrCl <30 or Hemodialysis
UD
Peritoneal Dialysis
Data currently are not available for patients receiving peritoneal dialysis. Until data
become available, begin with doses recommended for patients receiving hemodialysis and verify
adequacy of dosing using serum concentration monitoring.
Usual Dose (UD) Normal Renal Function
15 mg/kg/daily or thrice weekly
CrCl 30-90
UD
CrCl <30 or Hemodialysis
15 mg/kg/dose thrice weekly
Peritoneal Dialysis
Data currently are not available for patients receiving peritoneal dialysis. Until data
become available, begin with doses recommended for patients receiving hemodialysis and verify
adequacy of dosing using serum concentration monitoring.
Usual Dose (UD) Normal Renal Function
600 mg/day
CrCl 30-90
UD
CrCl <30 or Hemodialysis
UD
Peritoneal Dialysis
Data currently are not available for patients receiving peritoneal dialysis. Until data
become available, begin with doses recommended for patients receiving hemodialysis and verify
adequacy of dosing using serum concentration monitoring.
Standard doses are given unless there is intolerance.
The medications should be given after hemodialysis on the day of hemodialysis.
Monitoring of serum drug concentrations should be considered to ensure adequate drug absorption, without
excessive accumulation, and to assist in avoiding toxicity.
In patients with 30–50 mL/min creatinine clearance, standard doses are used by experts, but measurement
of serum concentrations 2 and 6 hours after timed administration can be used to assist with optimizing
drug dosages.
