| Active Substance | Standard Dose (GFR 90 and above) | GFR "60 - 89" Dose | GFR "45 - 59" Dose | GFR "30 - 44" Dose | GFR "15 - 29" Dose | GFR "Below 15" Dose | During Hemodialysis Treatment |
|---|---|---|---|---|---|---|---|
| Bisoprolol fumarate | 2.5 mg - 10 mg | 2.5 mg - 10 mg | 2.5 mg - 10 mg | 2.5 mg - 10 mg | 2.5 mg - 10 mg (20 - 29) 10 mg (maximum) (15 - 19) | 10 mg (maximum) | There's no proof that requires adjusting dose regimen in hemodialysis patients |
| Ertapenem sodium | 1 g | 1 g | 1 g | 1 g | 500 mg | 500 mg | 500 mg / day. A supplementary dose of 150 mg is recommended if administered within 6 hours prior to hemodialysis. If not, extra dose isn't needed |
| Imipenem / Cilastatin sodium | 2 - 4 g | Co-Ca* | Co-Ca* | Co-Ca* | Co-Ca* | Co-Ca* | Co-Ca* |
| Meropenem trihydrate | 500 mg - 1 gram every 8 hours | Recommended dose every 8 hours | Recommended dose every 8 hours (above 50) Recommended dose every 12 hours (45-50) | Recommended dose every 12 hours | Recommended dose every 12 hours (26-29) One-half recommended dose every 12 hours (15-25) | One-half recommended dose every 12 hours (10-14) One-half recommended dose every 24 hours (Below 10) | Inadequate information regarding its use on hemodialysis or peritoneal dialysis |
| Ciprofloxacin lactate | 200 – 400 mg IV every 12 h or 400 mg IV every 8 h | Normal dose | Normal dose | Normal dose | 200 – 400 mg every 18–24 hours | 200 – 400 mg every 18–24 hours (5-14) Dialysis result applies (Below 5) | 200 - 400 mg IV every 24 h (after hemodialysis on dialysis days) |
| Levofloxacin | 250 mg - 750 mg | Co-Ca* | Co-Ca* | Co-Ca* | Co-Ca* | Co-Ca* | Co-Ca* |
| Daptomicina | 4 - 6 mg / kg (Every 24 hours) | Normal dose | Normal dose | Normal dose | Co-Ca* | Co-Ca* | Co-Ca* |
| Teicoplanin | 200 - 800 mg / day | Normal dose | Normal dose / Every 2 days (or) Half of the normal dose / Every day | Normal dose / Every 3 days (or) 1/3 of the normal dose / once a day (30-39) Normal dose / Every 2 days (or) Half of the normal dose / once a day (40-44) | Normal dose / Every 3 days (or) 1/3 of the normal dose / once a day | Normal dose / Every 3 days (or) 1/3 of the normal dose / once a day | Normal dose / Every 3 days (or) 1/3 of the normal dose / once a day |
| Vancomycin hydrochloride | 500 mg / 6 hours (or) 1 g / 12 hours | Co-Ca* | Co-Ca* | Co-Ca* | Co-Ca* | Co-Ca* | Give one dose at 15 mg/kg actual body weight [rounded to nearest 250 mg]. Check a random vancomycin level 2 h after hemodialysis. If random level is ≤ 20 mcg/mL, repeat dose. If random level is > 20 mcg/mL, do not re-dose, repeat level after next dialysis |
| Piperacillin sodium / Tazobactam sodium | 13.5 g - 18 g / day (total for 2 active substances) | 3.375 g [as total] q6h // [4.5 g q6h for nosocomial pneumonia] | 3.375 g [as total] q6h // [4.5 g q6h for nosocomial pneumonia] | 3.375 g [as total] q6h // [4.5 g q6h for nosocomial pneumonia] (41-44) 2.25 g [as total] q6h // [3.375 g q6h for nosocomial pneumonia] (30-40) | 2.25 g [as total] q6h // [3.375 g q6h for nosocomial pneumonia] (20-29) 2.25 g [as total] q8h // [2.25 g q6h for nosocomial pneumonia] (15-19) | 2.25 g [as total] q8h // [2.25 g q6h for nosocomial pneumonia] | 2.25 g [as total] q12h // [2.25 g q8h for nosocomial pneumonia] |
| Fluconazole | 50 mg - 400 mg | Suggested percentage of dose = % 100 | Suggested percentage of dose = % 50 (45-50) Suggested percentage of dose = %100 (51-59) | Suggested percentage of dose = % 50 | Suggested percentage of dose = % 50 | Suggested percentage of dose = % 50 | The dose dedicated by the doctor according to indication may be applied following the hemodialysis treatment |
| Cefoperazone sodium / Sulbactam sodium | 3 g - 12 g (Total dose for 2 active substances) | Normal dose | Normal dose | Normal dose | 3 g / 12 hours (Total dose for 2 active substances) | 1.5 g / 12 hours (Total dose for 2 active substances) | During hemodialysis, half-life of the drug may be slightly shortened. So, doses should be arranged as to follow the dialysis time. |
| Colistimethate sodium | 2.5 to 5 mg/kg per day in 2 to 4 divided doses | 2.5 – 5 mg/kg, divided into 2 to 4 doses per day (80-89) 2.5 – 3.8 mg/kg, divided into 2 doses per day (60-79) | 2.5 – 3.8 mg/kg, divided into 2 doses per day (50-59) 2.5 mg/kg, once daily or divided into 2 doses per day (45-49) | 2.5 mg/kg, once daily or divided into 2 doses per day | 1.5 mg/kg every 36 hours | 1.5 mg/kg every 36 hours (10-14) 1.5 mg/kg IV or IM every 36 h (Below 10) | 1.5 mg/kg IV every 24–48 h |
| Tigecycline | Following the 100 mg of starting dose, 50 mg / 12 hours | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance |
| Moxifloxacin hydrochloride | 400 mg | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance |
| Linezolid | 600 mg / 12 hours | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Should be given after hemodialysis |
| Metronidazole | 1 - 4 g / day | Dose adjustment is not considered necessary | Dose adjustment is not considered necessary | Dose adjustment is not considered necessary | Monitoring for metronidazole associated adverse events is recommended | Monitoring for metronidazole associated adverse events is recommended | Supplementation following a hemodialysis session may be necessary |
| Perindopril arginine | 2.5 mg - 10 mg / day | 5 mg / day | 2.5 mg / day | 2.5 mg / day | 2.5 mg / 2 days | 2.5 mg following dialysis session | 2.5 mg following dialysis session |
| Perindopril arginine + Indapamide | One tablet per day | One tablet per day | Starting the treatment with the appropriate dose of free combination | Starting the treatment with the appropriate dose of free combination | Treatment is contraindicated | Treatment is contraindicated | Treatment is contraindicated |
| Ramipril | 1.25 mg - 10 mg | 1.25 mg - 10 mg | 1.25 mg - 10 mg (51-59) 1.25 mg / day for start. Maximum 5 mg / day (45-50) | 1.25 mg / day başlangıç. Maximum 5 mg / day | 1.25 mg / day başlangıç. Maximum 5 mg / day (20-29) There's not enough experience (15-20) | There's not enough experience | There's not enough experience |
| Ramipril + Hydrochlorothiazide | 2.5 mg / 12.5 mg - 10 mg / 25 mg | 2.5 mg / 12.5 mg - 10 mg / 25 mg | 1.25 mg ramipril (start) 2.5 mg ramipril / 12.5 mg hidroklorotiazid (maintenance) Daily maximum: 5 mg ramipril / 25 mg hidroklorotiazit | 1.25 mg ramipril (start) 2.5 mg ramipril / 12.5 mg hidroklorotiazid (maintenance) Daily maximum: 5 mg ramipril / 25 mg hidroklorotiazit | Contraindicated for the patients having severe renal insufficiency and receiving dialysis | Contraindicated for the patients having severe renal insufficiency and receiving dialysis | Contraindicated for the patients having severe renal insufficiency and receiving dialysis |
| Captopril | 25-50 mg / day for the start. Maximum daily dose is 150 mg | 25-50 mg / day for the start. Maximum daily dose is 150 mg | 25-50 mg / day for the start. Maximum daily dose is 150 mg | 25-50 mg / day for the start. Maximum daily dose is 150 mg (40-44) 25 mg / day for the start. Maximum daily dose is 100 mg (30-40) | 25 mg / day for the start. Maximum daily dose is 100 mg (21-29) 12.5 mg / day for the start. Maximum daily dose is 75 mg (15-20) | 12.5 mg / day for the start. Maximum daily dose is 75 mg (10-15) 6.25 mg / day for the start. Maximum daily dose is 37.5 mg (Less than 10) | Following the dialysis, dose may be applied between 20%-50% range or an extra dose may be applied between 25%-35% range |
| Olmesartan medoxomil | 10 mg / day for the start. Maximum daily dose is 40 mg | 10 mg / day for the start. Maximum daily dose is 40 mg | Daily maximum dose is 20 mg | Daily maximum dose is 20 mg | Daily maximum dose is 20 mg (20-29) Usage is not suggested (15-19) | Usage is not suggested | Usage is not suggested |
| Olmesartan medoxomil + Hydrochlorothiazide | 20 mg / 12.5 mg - 40 mg / 25 mg (a day) | 20 mg / 12.5 mg - 40 mg / 25 mg (a day) | 20 mg / 12.5 mg - 40 mg / 25 mg (a day) | 20 mg / 12.5 mg - 40 mg / 25 mg (a day) | Its use is contraindicated | Its use is contraindicated | No relevant information |
| Tramadol hydrochloride | Daily maximum 400 mg | There's no need for dose adjustment | There's no need for dose adjustment | There's no need for dose adjustment | 50 – 100 mg orally every 12 h as needed; maximum 200 mg/day | 50 – 100 mg orally every 12 h as needed; maximum 200 mg/day | 50 – 100 mg orally every 12 h as needed; maximum 200 mg/day; dose after hemodialysis on dialysis days |
| Acetaminophen (IV) | 650 mg orally or rectally or 1,000 mg IV every 6 h | 650 mg orally or rectally or 1,000 mg IV every 6 h | 650 mg orally or rectally or 1,000 mg IV every 6 h | 650 mg orally or rectally or 1,000 mg IV every 6 h | Longer dosing intervals and a reduced total daily dose of acetaminophen may be warranted | Longer dosing intervals and a reduced total daily dose of acetaminophen may be warranted | Longer dosing intervals and a reduced total daily dose of acetaminophen may be warranted |
| Spironolactone | 25 mg - 200 mg | Should not be used in the case of renal insufficiency | Should not be used in the case of renal insufficiency | Should not be used in the case of renal insufficiency | Should not be used in the case of renal insufficiency | Should not be used in the case of renal insufficiency | Should not be used in the case of renal insufficiency |
| Acetazolamide | 250 mg - 1000 mg | 250 mg - 1000 mg | 250 mg - 1000 mg (50-59) Dosing interval should be arranged as 12 hours (45-50) | Dosing interval should be arranged as 12 hours | Dosing interval should be arranged as 12 hours | Dosing interval should be arranged as 12 hours (10-15) Should be avoided to use. Treatment is considered as ineffective (Below 10) | It may be dialyzed in medium degree (20% - 50%) Should be avoided to use |
| Spironolactone + Hydrochlorothiazide | 50 mg - 400 mg (Total for 2 active substances) | Shouldn't be used during acute renal failure or significant disorders in renal excretion mechanisms | Shouldn't be used during acute renal failure or significant disorders in renal excretion mechanisms | Shouldn't be used during acute renal failure or significant disorders in renal excretion mechanisms | Shouldn't be used during acute renal failure or significant disorders in renal excretion mechanisms | Shouldn't be used during acute renal failure or significant disorders in renal excretion mechanisms | Shouldn't be used during acute renal failure or significant disorders in renal excretion mechanisms |
| Dexketoprofen | 100 mg - 150 mg (IV) | Total daily dose should be reduced to 50 mg | It shouldn't be used for the patients having moderate and severe renal insufficiency | It shouldn't be used for the patients having moderate and severe renal insufficiency | It shouldn't be used for the patients having moderate and severe renal insufficiency | It shouldn't be used for the patients having moderate and severe renal insufficiency | It shouldn't be used for the patients having moderate and severe renal insufficiency |
| Indapamide | 1.25 mg - 5 mg | 1.25 mg - 5 mg | 1.25 mg - 5 mg | 1.25 mg - 5 mg | Treatment is contraindicated | Treatment is contraindicated | Treatment is contraindicated |
| Metformin hydrochloride | 1000 mg - 3000 mg | Daily maximum dose (divided into 2 or 3) is 3000 mg | Daily maximum dose (divided into 2 or 3) is 2000 mg | Daily maximum dose (divided into 2 or 3) is 1000 mg | Treatment is contraindicated | Treatment is contraindicated | Treatment is contraindicated |
| Acarbose | Must be individualized. Maximum of 100 mg t.i.d. | Calculation is made according to SCr value | Calculation is made according to SCr value | Calculation is made according to SCr value | Calculation is made according to SCr value | Calculation is made according to SCr value | Data not available. Avoid unless no suitable alternative exists |
| Exenatide IV | 10 mcg - 20 mcg | 10 mcg - 20 mcg | 10 mcg - 20 mcg (50-59) Caution should be applied when initiating or escalating doses from 5 to 10 mcg (45-50) | Caution should be applied when initiating or escalating doses from 5 to 10 mcg | Its usage is not suggested | Its usage is not suggested | Its usage is not suggested |
| Oseltamivir phosphate | 75 mg - 150 mg (adults) | 75 mg in every 12 hours (once a day in prophylactic use) | 30 mg in every 12 hours (once a day in prophylactic use) | 30 mg in every 12 hours (once a day in prophylactic use) | 30 mg once a day (in every 2 days in prophylactic use) | 30 mg once a day (in every 2 days in prophylactic use) (10-15) There's no data, thus it's not recommended (below 10) | 30 mg after every hemodialysis session (after every 2nd session in prophylactic use) |
| Acyclovir (IV) | 5 - 10 mg/kg (every 8 hours) 500 mg/m2 (CMV prophylaxis) | Normal dose | Normal dose (50-59) The dose suggested should be given every 12 hours (45-50) | The dose suggested should be given every 12 hours | The dose suggested should be given every 12 hours (25-29) The dose suggested should be given every 24 hours (15-25) | The dose suggested should be given every 24 hours (10-15) The dose suggested should be halved and applied every 24 hours (below 10) | The dose suggested should be halved and applied after dialysis treatment every 24 hours |
| Fenofibrate | 160 mg - 267 mg | Dose should be reduced, thus it's usage is not suggested | Dose should be reduced, thus it's usage is not suggested | Dose should be reduced, thus it's usage is not suggested | Its use is contraindicated | Its use is contraindicated | Its use is contraindicated |
| Rosuvastatin kalsiyum | 5 mg - 40 mg | Normal dose | Starting dose is 5 mg. The dose of 40 mg is contraindicated | Starting dose is 5 mg. The dose of 40 mg is contraindicated | Its use is contraindicated | Its use is contraindicated | Its use is contraindicated |
| Zidovudin (IV) | 6 - 12 mg/kg | Normal dose | Normal dose | Normal dose | Normal dose | Normal dose (10-14) 1 mg/kg in every 6-8 hours (Below 10) | 100 mg in every 6-8 hours |
| Caspofungin acetate | 50 mg - 70 mg | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance |
| Vorikonazol (IV) | 6 - 8 mg/kg | Normal dose | Normal dose (50-59) It's suggested to switch to oral treatment (45-50) | It's suggested to switch to oral treatment | It's suggested to switch to oral treatment | It's suggested to switch to oral treatment | It's suggested to switch to oral treatment |
| Enoxaparin sodium | 2000 IU (total) - 150 IU (per kg) | Normal dose | Normal dose | Normal dose | Co-Ca* | Its usage is not suggested for the patients who has end stage renal disease (except hemodialysis) | 100 IU/kg. For the patients who are at high risk of high hemorrhage, dose should be reduced to 50 IU/kg (double vascular port) or 75 IU/kg (single vascular port) |
| Rivaroxaban | 5 mg - 10 mg | Normal dose | Normal dose | Normal dose | Normal dose | It's not suggested to be used | It's not suggested to be used |
| Anidulafungin | 100 mg - 200 mg | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance | Dose adjustment isn't needed for this active substance |
| Pregabalin | 150 mg - 600 mg | Starting dose: 150 mg, maximum dose: 600 mg. (Regimen: 2 or 3 times a day) | Starting dose: 75 mg, maximum dose: 300 mg. (Regimen: 2 or 3 times a day) | Starting dose: 75 mg, maximum dose: 300 mg. (Regimen: 2 or 3 times a day) | Starting dose: 25-50 mg, maximum dose: 150 mg. (Regimen: Once or twice a day) | Starting dose: 25 mg, maximum dose: 75 mg. (Regimen: Once a day) | In addition to the daily dose, an extra dose of 25 mg - 100 mg (following the dialysis session) |
| Gabapentin | 900 mg - 3600 mg | Daily dose range: 900 mg - 3,600 mg (≥80) Daily dose range: 600 mg - 1,800 mg (60-79) | Daily dose range: 600 mg - 1,800 mg (50-59) Daily dose range: 300 mg - 900 mg (45-49) | Daily dose range: 300 mg - 900 mg | Daily dose range: 150 mg - 600 mg. In the case of using the 150 mg dose, 300 mg should be applied every other day | Daily dose range: 150 mg - 300 mg. Dose should be reduced in proportion to the clearance value. In the case of using the 150 mg dose, 300 mg should be applied every other day | Daily dose range: 150 mg - 300 mg. In the case of using the 150 mg dose, 300 mg should be applied every other day. An extra dose of 200-300 mg is suggested following the dialysis session |
| Lithium carbonate | 300 mg - 1800 mg | Normal dose | Normal dose (51-59) %50 - %75 of the normal dose (45-50) | %50 - %75 of the normal dose | %50 - %75 of the normal dose | %50 - %75 of the normal dose (10-15) %25 - %50 of the normal dose (Below 10) | It's dialyzable (%50 - %100) and suggested to be applied following the dialysis treatment |
| Pitavastatin calcium | 1 mg - 4 mg | The dose of 4 mg may be used only if the patient is under close monitoring | The dose of 4 mg may be used only if the patient is under close monitoring | The dose of 4 mg may be used only if the patient is under close monitoring | The dose of 4 mg is not suggested for the patients having severe renal insufficiency | The dose of 4 mg is not suggested for the patients having severe renal insufficiency | The dose of 4 mg is not suggested for the patients having severe renal insufficiency |
| Paliperidone palmitate | 25 mg - 150 mg | Normal dose (80-89) First day 100 mg, one week later 75 mg. Monthly maintenance dose is 50 mg (60-79) | First day 100 mg, one week later 75 mg. Monthly maintenance dose is 50 mg (50-59) Not suggested to use (45-49) | Not suggested to use | Not suggested to use | Not suggested to use | Not suggested to use |
| Piracetam | 2400 mg - 24,000 mg | Normal daily total dose is applied as 2-4 equal doses (80-89) 2/3 of the normal daily total dose is applied as 2-3 equal doses (60-79) | 2/3 of the normal daily total dose is applied as 2-3 equal doses (50-59) 1/3 of the normal daily total dose is applied as 2 equal doses (45-49) | 1/3 of the normal daily total dose is applied as 2 equal doses | 1/6 of the normal daily total dose is applied in a single dose | Its use is contraindicated | Its use is contraindicated |
| Duloxetine hydrochloride | 30 mg - 120 mg | Normal dose | Normal dose | Normal dose | Not suggested | Not suggested | Not suggested |
| Fosfomycin sodium | 12 g - 24 g | Normal dose (81-89) It's advised to be cautious if doses on the upper limit are preferred (60-80) | It's advised to be cautious if doses on the upper limit are preferred | It's advised to be cautious if doses on the upper limit are preferred (41-44) % 70 of the normal dose is applied as divided in 2 or 3. Loading dose is %100 and 8 g (31-40) % 60 of the normal dose is applied as divided in 2 or 3. Loading dose is %100 and 8 g (30) | % 60 of the normal dose is applied as divided in 2 or 3. Loading dose is %100 and 8 g (21-29) % 40 of the normal dose is applied as divided in 2 or 3. Loading dose is %100 and 8 g (15-20) | % 40 of the normal dose is applied as divided in 2 or 3. Loading dose is %100 and 8 g (11-14) % 20 of the normal dose is applied as divided in 1 or 2. Loading dose is %100 and 8 g (below 11) | 2 g of fosfomycin should be applied following the dialysis session |
| Gentamicin sulfate | 3 - 5 mg/kg/day (q8h) | Normal dose with (sCr*8) hours intervals | Normal dose with (sCr*8) hours intervals | Normal dose with (sCr*8) hours intervals | Normal dose with (sCr*8) hours intervals | Normal dose with (sCr*8) hours intervals | 1 to 1.7 mg/kg at the end of each dialysis period depending upon the severity of the infection |
| Amikacin sulfate | 15 mg/kg/day IV once daily or divided into two or three equal doses | 7.5 mg/kg in every (sCr*9) hours | 7.5 mg/kg in every (sCr*9) hours | 7.5 mg/kg in every (sCr*9) hours | 7.5 mg/kg in every (sCr*9) hours | 7.5 mg/kg in every (sCr*9) hours | 3.75 mg/kg after dialysis |
| Ceftazidime pentahydrate | 1 – 2 g IV every 8 h or 6 g/24 h continuous IV infusion | Normal dose | Normal dose (51-59) 1 g in every 12 hours (45-50) | 1 g in every 12 hours (31-44) 1 g in every 24 hours (30) | 1 g in every 24 hours (16-29) 0.5 g in every 24 hours (15) | 0.5 g in every 24 hours (6-14) 0.5 g in every 48 hours (Below 6) | 1 g IV followed by 1 g IV after each hemodialysis |
| Ampicillin sodium / Sulbactam sodium | 1.5 – 3 g IV every 6 h | 1.5 – 3 g IV every 6 h | 1.5 – 3 g IV every 6 h (51-59) 1.5 – 3 g IV every 12 h (45-50) | 1.5 – 3 g IV every 12 h | 1.5 – 3 g IV every 12 h | 1.5 – 3 g IV every 12 h (10-14) 1.5 – 3 g IV every 24 h (Below 10) | 3 g IV every 24 h; administer after hemodialysis on dialysis days |
| Active Substance | Normal Dose (GFR 90 and above) | GFR "60 - 89" Dose | GFR "45 - 59" Dose | GFR "30 - 44" Dose | GFR "15 - 29" Dose | GFR "Below 15" Dose | During Hemodialysis Treatment |
*Co-Ca = Complex calculation is required