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Evaluation of dosage adjustment in patients with renal impairment
Author(s) -
Pillans P. I.,
Landsberg P. G.,
Fleming A.M.,
Fanning M.,
Sturtevant J. M.
Publication year - 2003
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1046/j.1445-5994.2003.00330.x
Subject(s) - medicine , medical prescription , renal function , creatinine , urology , emergency medicine , intensive care medicine , pharmacology
Aims: To determine whether appropriate dosage adjustments are made in patients with significant renal impairment for drugs with a high fractional renal clearance. Methods: Evaluation of dosage adjustment was performed in patients who were admitted to a 480‐bed metropolitan hospital (Princess Alexandra Hospital, Brisbane, Australia) with an estimated creatinine clearance of ≤40 mL/min. All drugs had a high fractional renal excretion. A prescribed dose within 30% of the calculated dose was considered appropriate. Results: Doses were found to be inappropriately high in 105 (42.2%) of 249 admission prescriptions of the targeted drugs. Doses were appropriately reduced in hospital in 32 patients (30.4%). Seventy‐three (29.3%) prescriptions were continued with excessive doses. Only 34 prescriptions for the target drugs were initiated in hospital, of which 88.2% were appropriately dosed. Conclusions: A significant percentage of patients with renal impairment are admitted to hospital on inappropriately high doses of drugs, with a high fractional renal excretion and low therapeutic index. Doses are appropriately reduced in hospital in some patients but there is still room for improvement. (Intern Med J 2003; 33: 10−13)