PharmPK Discussion - Dosage adjustment for kidney impaired patient

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On 30 Oct 2002 at 10:07:10, "SK. Abdul Mohammed Jafar Sadik Basha" (h2002032.-at-.bits-pilani.ac.in) sent the message


Dear all,
I would like to have some referrences or websites which can give
information on dosage regimen adjustment
1) when a kidney impaired patient is undergoing hemodailysis
2) when a kidney impaired patient is undergoing multidrug therapy
3) when a normal person is undergoing multidrug therapy (including all
possible drug interactions that can occur)

Thanks in advance
SK.BASHA

		*************************************
		*SK.ABDUL MOHAMMED JAFAR SADIK BASHA*
		*2002H108032			    *	
		*Room No.: 230, Bhagirath Bhavan    *
		*BITS, Pilani                       *
		*Rajasthan                          *
		*************************************

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On 18 Nov 2002 at 18:29:36, Roger Jelliffe (jelliffe.-a-.usc.edu) sent the message


Dear Dr. Basha:

You might try www.lapk.org. There is a good deal of info on
adjusting dosage to renal function, and a good method for estimating
CCr in unstable patients, where SCr is changing from day to day or dose
to dose. For aminoglycosides, hemodialysis adds about another 50 ML/min
to the patient's baseline CCr, which you can estimate from the most
recent rising pair of SCr's from post to pre-dialysis values, for
example. Use the USC*PACK programs. When a patient starts an episode of
dialysis, give a dose of 0.0 mg of drug, IV, over 0.1 hr, and add 50 to
the baseline CCr. When dialysis is over, give another dose of 0.0 mg IV
ver 0.1 hr, and set CCr back to the baseline value. In this way you can
include the dialysis episodes into the patient's dosage history, and
fit everything to the serum concentrations found.

For multidrug therapy, deal with each drug separately. As to
interactions, that is what therapeutic drug monitoring is all about.
Making an individual model of drug behavior takes into account all the
interactions we know about, as well as all the ones we have not yet
discovered. That is the strength of good TDM and Bayesian adaptive
control of drug regimens. Simply deal thoughtfully with each drug
separately.

There are a number of teaching topics on our web site, and also
info about the software.

Very best regards,

Roger Jelliffe
Roger W. Jelliffe, M.D. Professor of Medicine,
Division of Geriatric Medicine,
Laboratory of Applied Pharmacokinetics,
USC Keck School of Medicine
2250 Alcazar St, Los Angeles CA 90033, USA
email jelliffe.at.usc.edu
Our web site http://www.lapk.org

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