Renal Impairment. Monitor renal function closely if eGFR trending downwards. Check for other causes e.g. dehydration, infection etc. Repeat U&Es when patient stable and if still reduced renal function contact the HF team for advice. An increase in creatinine up to 50% above baseline or 266micromol/l, whichever is smaller is acceptable. If creatinine increases by >100% or to above 310 micromol/l sacubitril/valsartan should be stopped and specialist advice sought. Hepatic impairment Severe hepatic impairment, biliary cirrhosis or cholestasis (Child-Xxxx C classification) discontinue sacubitril/valsartan. Moderate liver impairment; consider dose reduction (Child-Xxxx B classification) and contact HF team for advice. Angioedema Discontinue sacubitril/valsartan if angioedema occurs. Patient should be given appropriate therapy and monitored for airway compromise. Refer to secondary care.
Renal Impairment. In patients with impaired renal function, there is no need to reduce the dosage of ceftriaxone provided hepatic function is not impaired. Only in cases of preterminal renal failure (creatinine clearance < 10 ml/min) should the ceftriaxone dosage not exceed 2 g daily. In patients undergoing dialysis no additional supplementary dosing is required following the dialysis. Ceftriaxone is not removed by peritoneal or haemodialysis. Close clinical monitoring for safety and efficacy is advised. Ceftriaxone special warnings and precautions for use: Hypersensitivity reactions Serious and occasionally fatal hypersensitivity reactions have been reported with ceftriaxone Severe cutaneous adverse reactions (Xxxxxxx Xxxxxxx syndrome or Lyell's syndrome/toxic epidermal necrolysis) have been reported. For severe reactions, treatment with ceftriaxone must be discontinued immediately and adequate emergency measures must be initiated. Before beginning treatment, establish whether the patient has a history of severe hypersensitivity reactions to ceftriaxone, to other cephalosporins or to any other type of beta-lactam agent. Caution should be used if ceftriaxone is given to patients with a history of non-severe hypersensitivity to other beta- lactam agents. Interaction with calcium containing products Ceftriaxone must not be mixed or administered simultaneously with any calcium-containing intravenous solutions, even via different infusion lines or at different infusion sites. Immune mediated haemolytic anaemia Severe cases of haemolytic anaemia, including fatalities, have been reported. If a patient develops anaemia while on ceftriaxone, the diagnosis of a cephalosporin-associated anaemia should be considered and ceftriaxone discontinued until the aetiology is determined. During prolonged treatment complete blood count should be performed at regular intervals. Colitis/Overgrowth of non-susceptible Antibacterial agent-associated colitis and pseudo-membranous colitis have been reported Discontinuation of therapy with ceftriaxone and the administration of specific treatment for Clostridium microorganisms with nearly all antibacterial agents, including ceftriaxone, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea during or subsequent to the administration of ceftriaxone. difficile should be considered. Medicinal products that inhibit peristalsis should not be given. Biliary lithiasi...
Renal Impairment. Adults and elderly patients with impaired renal function Dose adjustment is not required until the fourth day of treatment, at which time dosing should be adjusted to maintain a serum trough concentration of at least 10 mg/L. After the fourth day of treatment: • In mild and moderate renal insufficiency (Creatinine Clearance 30-80 ml/min): maintenance dose should be halved, either by administering the dose every two days or by administering half of this dose once a day. • In severe renal insufficiency (Creatinine Clearance less than 30 ml/min) and in haemodialysed patients: dose should be one-third the usual dose, either by administering the initial unit dose every third day or by administering one-third of this dose once a day. Teicoplanin is not removed by haemodialysis. ▼Teicoplanin - Special warnings and precautions for use: Use teicoplanin with caution when it is co-administered with potentially nephrotoxic drugs. Hypersensitivity reactions Serious, life-threatening hypersensitivity reactions, sometimes fatal (e.g. anaphylactic shock) Discontinue treatment immediately. Initiate appropriate emergency measures. Hypersensitivity to vancomycin Cross - hypersensitivity reactions, including fatal anaphylactic shock, may occur. Teicoplanin must be administered with caution Infusion related reactions Rarely (even at the first dose), red man syndrome (a complex of symptoms including pruritus, urticaria, erythema, angioneurotic oedema, tachycardia, hypotension, dyspnoea) Stop or slow the infusion. Administer the daily dose as a 30 minute infusion instead of a bolus. Severe bullous reactions Life-threatening or even fatal cutaneous reactions Xxxxxxx-Xxxxxxx syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) (e.g. progressive skin rash often with blisters or mucosal lesions) Discontinue teicoplanin treatment immediately. Seek medical advice. Ototoxicity Deafness, hearing loss, tinnitus and vestibular disorder Assess whether the patient is on other ototoxic, nephrotoxic and neurotoxic drugs. Seek advice from P@H Thrombocytopenia Weekly FBC recommended Seek advice from P@H Nephrotoxicity Teicoplanin is excreted renally and rarely can cause renal failure Seek advice from P@H - the dose may need to be reduced. ▼Teicoplanin - Adverse Effects and Management Adverse effects Symptoms/signs Actions Leucopenia, thrombocytopenia, eosinophilia, agranulocytosis, neutropenia Fever, severe chills, sore throat, mouth ulcers Refer patient to P@H. Deafness, hearing loss, tinnitus,...
Renal Impairment. Avoid BARHEMSYS in patients with severe renal impairment (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2). The pharmacokinetics of amisulpride in patients with severe renal impairment have not been adequately studied in clinical trials. Amisulpride is known to be substantially excreted by the kidneys, and patients with severe renal impairment may have increased systemic exposure and an increased risk of adverse reactions. No dosage adjustment is necessary in patients with mild to moderate renal impairment (eGFR ≥ 30 mL/min/1.73 m2). Drug Interactions • BARHEMSYS causes dose- and concentration-dependent QT prolongation. To avoid potential additive effects, avoid use of BARHEMSYS in patients taking droperidol. • ECG monitoring is recommended in patients taking other drugs known to prolong the QT interval (e.g., ondansetron). • Reciprocal antagonism of effects occurs between dopamine agonists (e.g., levodopa) and BARHEMSYS. Avoid using levodopa with BARHEMSYS.
Renal Impairment. The pharmacokinetics of eszopiclone were studied in 24 patients with mild, moderate, or severe renal impairment. AUC and Cmax were similar in the patients compared with demographically matched healthy control subjects. No dose adjustment is necessary in patients with renal impairment, since less than 10% of the orally administered eszopiclone dose is excreted in the urine as parent drug. Drug Interactions Eszopiclone is metabolized by CYP3A4 and CYP2E1 via demethylation and oxidation. There were no pharmacokinetic or pharmacodynamic interactions between eszopiclone and paroxetine, digoxin, or warfarin. When eszopiclone was coadministered with olanzapine, no pharmacokinetic interaction was detected in levels of eszopiclone or olanzapine, but a pharmacodynamic interaction was seen on a measure of psychomotor function. Eszopiclone and lorazepam decreased each other’s Cmax by 22%. Coadministration of eszopiclone 3 mg to subjects receiving ketoconazole 400 mg, a potent inhibitor of CYP3A4, resulted in a 2.2-fold increase in exposure to eszopiclone. LUNESTA would not be expected to alter the clearance of drugs metabolized by common CYP450 enzymes. (See PRECAUTIONS.) CLINICAL TRIALS: The effect of LUNESTA on reducing sleep latency and improving sleep maintenance was established in studies with 2100 subjects (ages 18-86) with chronic and transient insomnia in six placebo-controlled trials of up to 6 months’ duration. Two of these trials were in elderly patients (n=523). Overall, at the recommended adult dose (2-3 mg) and xxxxxxx xxxx (0-0 xx), XXXXXXX significantly decreased sleep latency and improved measures of sleep maintenance (objectively measured as wake time after sleep onset [WASO] and subjectively measured as total sleep time).
Renal Impairment. The effect of renal impairment on the pharmacokinetics of APADAZ has not been determined. Patients with renal impairment may have higher plasma concentrations than those with normal function. Use a low initial dose of APADAZ in patients with renal impairment and monitor closely for adverse events such as respiratory depression.
Renal Impairment. The effect of renal insufficiency on the pharmacokinetics of APADAZ has not been determined [see Use in Specific Populations (8.7)].
Renal Impairment. The potential risks and benefits of anagrelide therapy in a patient with impairment of renal function should be assessed before treatment is commenced. Cardiovascular Serious cardiovascular adverse events including cases of cardiomyopathy, cardiomegaly, congestive heart failure and cardiac arrhythmias have been reported. Anagrelide should be used with caution in patients of any age with known or suspected heart disease. Moreover, serious cardiovascular adverse events have also occurred in patients without suspected heart disease and with normal pre-treatment cardiovascular examination. Anagrelide should only be used if the potential benefits of therapy outweigh the potential risks. Anagrelide is an inhibitor of cyclic AMP phosphodiesterase III and because of its positive inotropic effects, a pre-treatment cardiovascular examination (including further investigation such as echocardiography, electrocardiogram) is recommended. Patients should be monitored during treatment for evidence of cardiovascular effects that may require further cardiovascular examination and investigation. Drug Interactions The effects of inotropes may be exacerbated by anagrelide but no other clinically significant interactions have been documented. There is no interaction with drugs commonly co-prescribed – warfarin, aspirin, hydroxycarbamide and allopurinol. Anagrelide may cause intestinal disturbance in some patients and compromise the absorption of hormonal oral contraceptives. Sources of information If you have any concerns regarding individual patients, the most recent patient letters from the Haematology Medical Team will contain our up-to-date contact details or you can contact one of the following: Clinical Haematology Secretaries 023 9228 6311 GP medical Advice line 9am – 5pm 023 9228 6000 Bleep 1972 Haematology & Oncology patient EmergencyNumber 023 9228 3316 Haematology & Oncology Unit Day xxxx 023 9228 6000 Ext 3117 Haematology and Oncology Pharmacy 023 9228 6000 Ext 5424 The on-call Haematologist is available via switchboard if advice is required out of hours Costs per month – depends on daily dose The cost of a 100 capsule pack of Anagrelide 0.5mg is £397 (excluding VAT) References:
Renal Impairment. Bupivacaine is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Care should be taken in dose selection of EXPAREL.
Renal Impairment. Bupivacaine is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Care should be taken in dose selection of EXPAREL [See Use in Specific Populations (8.7)]. Age Various pharmacokinetic parameters of the local anesthetics such as bupivacaine can be significantly altered by the age of the patient. In clinical studies, differences in various pharmacokinetic parameters have been observed between elderly and younger patients. Bupivacaine is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection of EXPAREL [See Use in Specific Populations (8.5)].
