Dialysis Drugs 2010

2010
Dialysis of Drugs
Curtis A. Johnson, PharmD CKD Insights, LLC Verona, Wisconsin and Professor (Emeritus) of Pharmacy and Medicine University of Wisconsin-Madison Madison, Wisconsin
2010 Dialysis of Drugs
DISCLAIMERThese Dialysis of Drugs guidelines are offered as a general summary of information for pharmacists and other medical professionals. Inappropriate administration of drugs may involve serious medical risks to the patient that can only be identied by medical professionals. Depending on the circumstances, the risks can be serious and can include severe injury, including death. These guidelines cannot identify medical risks specic to an individual patient or recommend patient treatment. These guidelines are not to be used as a substitute for professional training. The absence of typographical errors is not guaranteed. Use of these guidelines indicates acknowledgment that neither CKD Insights, LLC. nor Genzyme will be responsible for any loss or injury, including death, sustained in connection with or as a result of the use of these guidelines. Readers should consult the complete information available in the package insert for each agent indicated before prescribing medications. Guides such as this one can only draw from information available as of the date of publication. Neither CKD Insights, LLC. nor Genzyme is under any obligation to update information contained herein. Future medical advances or product information may affect or change the information provided. Pharmacists and other medical professionals using these guidelines are responsible for monitoring ongoing medical advances relating to dialysis. Copyright 2010, CKD Insights, LLC. Printed in the U.S.A. All rights reserved. This material may not be published, rewritten or redistributed.
SEE DISCLAIMER REGARDING USE OF THIS GUIDE
I PREFACE
Preface
Drug removal during dialysis is frequently of interest to those caring for patients receiving hemodialysis or peritoneal dialysis. The extent of drug dialyzability determines whether supplemental dosing is necessary during or following dialysis. The accompanying table is a reference regarding the effect of either form of dialysis on drug clearance. This table should be used as a general guideline. The drugs included in the table are parent drugs. In some cases, these drugs are converted to pharmacologically active or toxic metabolites for which little dialysis information is known. Therefore, for a few drugs, a primary metabolite is also included in the table. When available, serum drug measurements may be appropriate for dosing individual patients. In all cases, patients should be monitored for clinical efcacy and toxicity.
What Determines Drug Dialyzability?

The extent to which a drug is affected by dialysis is determined primarily by several physicochemical characteristics of the drug that are briey described in the text that follows. These include molecular size, protein binding, volume of distribution, water solubility, and plasma clearance. In addition to these properties of the drug, technical aspects of the dialysis procedure also may determine the extent to which a drug is removed by dialysis.
Molecular Weight
Dialysis is dependent upon the use of a dialytic membrane: either a synthetic membrane with xed pore size, as in hemodialysis, or a naturally occurring peritoneal membrane, as in peritoneal dialysis. The movement of drugs or other solutes is largely determined by the size of these molecules in relation to the pore size of the membrane. As a general rule, smaller molecular weight substances will pass through the membrane more easily than larger molecular weight substances. A common assumption is that pore size of the peritoneal membrane is somewhat larger than that of the hemodialysis membrane. This would explain the observation that larger molecular weight substances appear to cross the peritoneal membrane to a greater extent than the hemodialysis membrane.
Protein Binding
Another important factor determining drug dialyzability is the concentration gradient of unbound (free) drug across the dialysis membrane. Drugs with a high degree of protein binding will have a low plasma concentration of unbound drug available for dialysis. Uremia may have an effect on protein binding for some drugs. Through mechanisms not completely understood, protein binding may decrease in uremic serum. Should this change in binding be substantial, increased dialyzability of free drug may occur.
Because the primary binding proteins for most drugs (albumin, 1-acid glycoprotein) are of large molecular size, the drug-protein complex is often unable to cross the dialysis membrane, especially the hemodialysis membrane. Since the peritoneal membrane does permit the passage of some proteins, there may be some limited drug-protein removal with peritoneal dialysis. Increased protein concentrations often occur in peritoneal efuent during episodes of peritonitis.
I PREFACE
Volume of Distribution
A drug with a large volume of distribution is distributed widely throughout tissues and is present in relatively small amounts in the blood. Factors that contribute to a large volume of distribution include a high degree of lipid solubility and low plasma protein binding. Drugs with a large volume of distribution are likely to be dialyzed minimally.
Water Solubility
The dialysate used for either hemodialysis or peritoneal dialysis is an aqueous solution. In general, drugs with high water solubility will be dialyzed to a greater extent than those with high lipid solubility. Highly lipid-soluble drugs tend to be distributed throughout tissues, and therefore only a small fraction of the drug is present in plasma and accessible for dialysis.
Plasma Clearance
The inherent metabolic clearancethe sum of renal and nonrenal clearanceis often termed the plasma clearance of a drug. In dialysis
SEE DISCLAIMER REGARDING USE OF THIS GUIDE 5
patients, renal clearance is largely replaced by dialysis clearance. If nonrenal clearance is large compared to renal clearance, the contribution of dialysis to total drug removal is low. However, if renal (dialysis) clearance increases plasma clearance by 30% or more, dialysis clearance is considered to be clinically important.
Dialysis Membrane
As mentioned previously, the characteristics of the dialysis membrane determine to a large extent the dialysis of drugs. Pore size, surface area, and geometry are the primary determinants of the performance of a given membrane. The technology of hemodialysis has evolved, and new membranes have been introduced for clinical use. Interpretation of published literature should be tempered with the understanding that newer hemodialysis membranes may have different drug dialysis characteristics. Little can be done to alter the characteristics of the peritoneal membrane.
Blood and Dialysate Flow Rates

The hemodialysis prescription includes the desired blood and dialysate ow rates. As drugs normally move from blood to dialysate, the ow rates of these two substances may have a pronounced effect on dialyzability. In general, increased blood ow rates during hemodialysis will deliver greater amounts of drug to the dialysis membrane. As the drug concentration increases in the dialysate, the ow rate of the dialysis solution also becomes important in overall drug removal. Greater dialysis can be
6 SEE DISCLAIMER REGARDING USE OF THIS GUIDE
achieved with faster dialysate ow rates that keep the dialysate drug concentration at a minimum. During peritoneal dialysis, little can be done to alter blood ow rates to the peritoneum. However, dialysate ow rates are determined by the volume and frequency of dialysate exchange in the peritoneum. At low exchange rates, drug concentrations in the dialysate will increase during the time in which the dialysate resides in the peritoneum, thus slowing additional movement of drug across the membrane. More frequent exchanges will favor increased drug dialyzability, provided the drugs physicochemical characteristics permit its movement across the peritoneal membrane.
I SPECIAL CONSIDERATIONS
Special Considerations
HIGH PERMEABILITY DIALYSIS Much of the information contained in this guide has been obtained from studies conducted under conditions of standard hemodialysis that employed conventional dialysis membranes. Changes in dialysis technology have led to more permeable dialysis membranes and the opportunity to employ higher blood and dialysate ow rates. These new technologies are often referred to as high permeability, high-efciency, and high-ux dialysis. The United States Food and Drug Administration has classied high permeability dialysis membranes as those whose in vitro ultraltration coefcient (KUf) is greater than 8 mL/hour/mm Hg. Commonly included in this group of dialysis membranes are polysulfone, polyacrylonitrile,
and high-efciency cuprammonium rayon dialyzers. Changes in dialysis membranes and changes in blood and dialysis ow rates may have clinically important effects on drug removal through the membrane. There are an increasing number of studies that examine the effects of high permeability dialysis on drug dialyzability. Results of these studies conrm predictions that drug removal from plasma is often enhanced as compared with more traditional dialysis membranes. Studies with high permeability dialysis also demonstrate that removal of drug from plasma often exceeds the transfer of drug from tissues to plasma. As a result, a rebound of plasma drug concentrations following the conclusion of dialysis may occur as blood-tissue drug equilibration occurs. Patients receiving high permeability dialysis may require more drug compared with those receiving standard hemodialysis. Due to the many technical and physiological variables, individualized therapeutic drug monitoring may be necessary. The reader is referred to the primary literature for further details. CONTINUOUS RENAL REPLACEMENT THERAPY Another therapeutic development that will affect drug dialyzability is continuous renal replacement therapy (CRRT), known in its various forms as continuous arteriovenous hemoltration (CAVH), continuous venovenous hemoltration (CVVH), continuous arteriovenous hemodialysis (CAVHD), continuous venovenous hemodialysis (CVVHD),
continuous venovenous hemodialtration (CVVHDF), continuous arteriovenous hemodialtration (CAVHDF), slow continuous ultraltration (SCUF), continuous arteriovenous high-ux hemodialysis (CAVHFD), and continuous venovenous high-ux hemodialysis (CVVHFD). These various techniques are used in the management of acute renal failure in critically ill patients. Continuous renal replacement therapies differ considerably from intermittent hemodialysis. Relying heavily upon continuous ultraltration of plasma water, CRRT has the potential for the removal of large quantities of ultralterable drugs contained in plasma. Unfortunately, few in vivo studies have been published, and very few drugs have been studied pharmacokinetically in intensive care patients. Therefore, many guidelines for drug dosing during CRRT are extrapolated from experiences with chronic hemodialysis or from theoretical considerations based upon general principles of drug removal derived from the physicochemical characteristics of the drug and the CRRT technique employed. Molecular weight of a drug has been an important determinant of drug dialyzability in conventional hemodialysis. This drug characteristic becomes less important during CRRT because of the use of highux hemolters that permit passage of larger molecules up to 5000 Da. As is true with conventional hemodialysis, drugs with a large volume of distribution are unlikely to be removed to a great extent during CRRT. Most
of the body stores of such drugs are outside the vascular compartment and not accessible to the hemolter for removal. Similarly, drugs that are highly bound to plasma proteins are not subject to signicant removal during CRRT because the molecular weight of drug-protein complexes usually hinders passage of the complex across the lter. The fraction of unbound drug may change during renal failure, however, thus altering the likelihood of drug removal. If the unbound fraction increases, more drug clearance may occur. If the unbound fraction becomes less, there is likely to be less drug removal during CRRT. A useful tool to predict the likelihood of a drug to cross the hemolter membrane is the sieving coefcient. This term is dened as the ratio of drug concentration in the ultraltrate to the prelter plasma water concentration of the drug. If the sieving coefcient is close to 1.0, the drug has relatively free passage across the lter. The following table presents sieving coefcient data from in vitro and in vivo evaluations. SIEVING COEFFICIENT
Drug Name Amikacin Amphotericin Ampicillin Cefotaxime Cefoxitin Ceftazidime Ceftriaxone
10
Predicted Measured Condition Filter 0.95 0.88 in vivo PSa 0.10 0.40 in vivo PSa 0.80 0.69 in vivo PSa 0.62 0.51 in vivo PSa 0.30 0.30 in vitro PSa 0.90 0.90 in vivo PSa 0.10 0.71 in vivo PSa
Drug Name Cefuroxime Clindamycin Digoxin
Predicted Measured Condition Filter 0.66 0.59 in vivo PSa 0.40 0.80 0.98 0.96 0.35 0.18 1.21 1.07 in vivo in vivo in vitro in vitro in vitro in vitro in vivo in vivo in vivo in vivo in vivo in vivo in vivo in vivo in vivo in vitro in vitro in vitro in vitro in vitro in vivo in vitro in vitro in vivo in vivo in vitro PSa PSa PSa PSb AN69c PAd PSa PSa PSa PSa PSa PSa PSa PSa PSa PSa PSb AN69c PAd PSa PSa PSa AN69c PAd PSa PSa
11
Erythromycin Gentamicin Metronidazole Mezlocillin N-acetylprocainamide Nafcillin Oxacillin Phenobarbital Phenytoin
0.30 0.95 0.80 0.68 0.90 0.20 0.05 0.60 0.10
0.37 0.81 0.86 0.68 0.92 0.54 0.02 0.86 0.45 0.14 0.12 0.08 0.17 0.08
Procainamide Theophylline
0.86 0.47
0.86 0.85 0.93 0.78
Tobramycin
0.95
0.78 0.90
Drug Name Tobramycin
Valproic acid
Vancomycin
Predicted Measured Condition Filter 0.95 0.75 in vitro PSb 0.59 in vitro AN69c 0.76 in vitro PAd 0.10 0.18 in vitro PSa 0.31 in vitro AN69c 0.16 in vitro PAd 0.90 0.76 in vivo PSa 0.60 in vitro PSa 0.71 in vitro PSb 0.64 in vitro AN69c 0.58 in vitro PAd
Amicon dialter (polysulfone) Renal System (polysulfone) c Hospal (AN69) d Gambro (polyamide) The above table was published in the following article: Joy MS, Matzke, GR, Armstrong DK, Marx MA, Zarowitz BJ. A primer on continuous renal replacement therapy for critically ill patients. Ann Pharmacother. 1998;32:362-75. Reprinted with permission. Harvey Whitney Books Company.
b
The specic CRRT technique employed will inuence the ultraltration rate and hence, the potential rate of drug removal. When CRRT relies solely on spontaneous blood ow without extracorporeal blood pumping, an ultraltration rate of 10-15 mL/min is anticipated. The addition of blood pumps and continuous dialysis may increase the ultraltration rate to 50 mL/min. Higher rates of ultraltration may lead to greater drug removal with a need for more
frequent replacement doses. Drug removal can be determined by collection of the total volume of dialysate/ultraltrate and measurement of the concentration of drug in the efuent. Because of the multiple techniques employed in CRRT, the variability in individual patient circumstances, and the lack of in vivo data, the tables in this guide do not contain information on drug removal during CRRT. Once again, the reader is referred to the primary literature for assistance with the dosing of specic drugs. PLASMAPHERESIS Plasmapheresis is another special consideration in which drug removal from plasma may be of concern. This technique is used for the treatment of certain immunologic, infectious, and metabolic diseases, as well as for the removal of toxins that cannot be removed by hemodialysis or peritoneal dialysis. Plasmapheresis removes plasma from the patient with replacement by crystalloid or colloid solutions. Solutes such as drug molecules that are present in the plasma may be removed from the patient. Unfortunately, little is known about the specic pharmacokinetic effects of plasmapheresis. The procedure may be most likely to remove substances that are lipophilic, that are highly protein-bound, and that have a small volume of distribution. The reader is referred to reference 5. SUMMARY Drug dialyzability is determined by a complex interaction of many factors, including the characteristics of the drug and the technical
aspects of the dialysis system. Published studies on drug dialyzability should specify the conditions that pertain during dialysis. Results from these studies should be applied with caution to other dialysis conditions.
About This Guide

These guidelines are designed to provide extensive, easy-to-read information regarding the dialyzability of drugs. Numerous literature sources have been used in preparing the guidelines. For many drugs, including newlyapproved medications, no studies have been done to determine the effect of dialysis on drug removal. In some cases, the available data may conict. Conditions of dialysis used in published studies may not necessarily reect current dialysis procedures and technology. Variations in the duration of dialysis, ow rates, dialysis membranes, and whether peritoneal dialysis is continuous or intermittent will all affect drug removal. This educational review will distinguish between conventional hemodialysis and high permeability (often called high-ux) hemodialysis where such data are available. However, the review does not contain information on drug dialyzability with CRRT (See Special Considerations, page 8) or with plasmapheresis. For additional information on specic drugs, the reader should consult the primary literature. A designation of Yes in the Hemodialysis and Peritoneal Dialysis columns indicates that dialysis enhances plasma clearance by 30% or more. Supplemental dosing may be required or dosing after dialysis should be considered.
No indicates that dialysis does not have a clinically important effect on plasma clearance. Supplemental dosing is usually not required. As a general principle, usual methods of continuous ambulatory peritoneal dialysis (CAPD) provide relatively low drug clearances during any given dialysate exchange. However, cumulative drug removal may require dosage supplementation at appropriate intervals. Relatively little research has examined peritoneal drug clearance in PD techniques that utilize automated systems employing large volumes of short dwells at night, often accompanied by one or more longer daytime dwells (APD). Similarly, little data exists on the effects of tidal peritoneal dialysis on drug clearance. A few studies have conrmed that clearance of some drugs is increased by APD due to the increased drug concentration gradient between blood and dialysate. Increased drug dialyzability may occur with increased peritoneal dialysate ow rates or in the presence of peritonitis. A designation of U indicates that no dialysis studies have been published, but that the author of this guide has concluded that signicant drug removal during dialysis is unlikely based upon the physicochemical characteristics of the drug, which are primarily a high degree of protein binding, a large molecular weight, or a large volume of distribution. A designation of L indicates that no published data exist on the removal of the drug during high permeability dialysis. However, the author has extrapolated data from studies using conventional dialysis to conclude that signicant drug removal is likely to occur during high permeability dialysis. A designation of ND indicates that no data are
I ABOUT THIS GUIDE
available on drug dialyzability. In some cases, the literature reports the use of a high permeability, or high-ux, dialysis membrane, however the type of membrane is not specied. A designation of NS indicates membrane type is not specied.
Key
Yes Indicates that dialysis enhances plasma clearance by 30% or more. Supplemental dosing may be required or dosing after dialysis should be considered. No Indicates that dialysis does not have a clinically important effect on plasma clearance. Supplemental dosing is usually not required. U Indicates signicant drug removal is unlikely based on physicochemical characteristics of the drug such as protein binding, molecular size or volume of distribution L Indicates no published data exist, but information extrapolated from studies using conventional dialysis techniques suggests signicant drug removal is likely during high permeability dialysis ND Indicates there are no data on drug dialyzability with this type of dialysis NS Indicates the type of membrane was not specied * Removed with hemoperfusion Note: In these tables, conventional hemodialysis is dened as the use of a dialysis membrane whose in vitro coefcient of ultraltration (KUf) 8 mL/hour/mm Hg. Data also are placed in the conventional column if the literature does not specify the type of dialysis membrane employed. High permeability hemodialysis is dened as the use of a dialysis membrane whose KUf >8 mL/hour/mm Hg. In the tables, the KUf of the membrane(s) used is included in parentheses.
I CHART
Drug
HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis
Abacavir Abatacept Abciximab Acamprosate Acarbose Acebutolol (diacetolol) Acetaminophen Acetazolamide Acetohexamide Acetophenazine Acetylcysteine Acitretin Acrivastine Acyclovir Adalimumab Adefovir Adenosine Agalsidase alfa Agalsidase beta Albendazole Albumin Albuterol Aldesleukin Alefacept Alemtuzumab Alendronate Alfentanil Alfuzosin Alglucerase Aliskiren
U U U ND ND Yes (NS) Yes (NS) U U U Yes (7.5) No (NS) ND Yes (NS) U Yes (NS) U No (7.5) U No (NS) U No (NS) ND ND U No (NS) U U U ND
No (40) U ND ND ND L L ND ND ND ND U ND L U ND ND No (10) U ND ND ND ND ND U ND ND U U ND
ND U U ND ND ND No No U U ND U ND No U ND U U U U U U ND ND U ND U U U ND
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Drug
Allopurinol Almotriptan Alosetron Alprazolam Alprostadil Alteplase Altretamine Alvimopan Amantadine Ambenonium Ambrisentan Amdinocillin Amifostine Amikacin Amiloride Aminocaproic acid Aminoglutethimide Aminosalicylic acid Amiodarone Amitriptyline Amlodipine Amoxapine Amoxicillin Amphetamine Amphotericin B Amphotericin B lipid complex Ampicillin Amprenavir Amrinone
18
Yes (NS) ND ND No (NS) U U ND ND No (NS) ND U No (NS) ND Yes (NS) ND Yes (NS) Yes (NS) Yes (NS) No (NS) No (NS) No (NS) U Yes (NS) ND No (NS) No (NS) Yes (NS) U U
L ND ND ND No (11.1) ND ND ND ND ND U ND ND L ND ND L L U ND U U L ND No (10.1, 36) ND L ND ND
ND ND ND U ND U ND ND No ND U No ND Yes ND Yes ND ND No No No U No ND No U No U No
I CHART
Drug
Amsacrine U Anagrelide ND Anakinra No (NS) Anastrozole ND Anidulafungin No (NS) Anisindione U Anisoylated plasminogen ND streptokinase activator complex Anistreplase U Antithymocyte globulin U (ATG) Apomorphine U Aprepitant No (NS) Aprotinin U Arbutamine ND Argatroban U Aripiprazole U Armodanil ND Arsenic trioxide No (NS) Artemether/ ND lumefantrine Articaine ND Ascorbic acid Yes (5.5) Asparaginase U Aspirin Yes (NS) Atazanavir U Atenolol Yes (NS) Atomoxetine U Atorvastatin No (NS)
U ND ND ND U U ND ND ND U U ND ND No (10.7-36) U ND ND ND ND Yes (8.8) ND L U L U U
U ND No ND U U ND U U U U U ND ND U ND U ND ND Yes U Yes U No U U
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Drug
Atovaquone Atracurium Atropine Auranon Azacitidine Azathioprine Azelastine Azithromycin Azlocillin Aztreonam Baclofen Balsalazide Basiliximab Benazepril (benazeprilat) Bendamustine Bendroumethiazide Benzphetamine Benzquinamide Benztropine Bepridil Beractant Besioxacin Betamethasone Betaxolol Bethanechol Bevacizumab Bexarotene Bezabrate Biapenem
20
U U No (NS) No (NS) ND Yes (NS) U ND Yes (NS) Yes (NS) ND U U No (NS) U No (NS) ND U ND No (NS) U ND ND No (NS) ND U U No (NS) Yes (NS)
ND ND ND ND ND L U ND L L Yes (60) U ND ND U ND ND ND ND ND U ND ND ND ND No (NS) U U Yes (NS)
U U ND ND ND ND U No No No ND U U ND U U ND ND ND U U ND ND No ND U U No ND
I CHART
Drug
Bicalutamide Biperiden Bisoprolol Bivalirudin Bleomycin Bortezomib Bosentan Bretylium Bromfenac Bromocriptine Brompheniramine Budesonide Buomedil Bumetanide Bupivacaine Buprenorphine Bupropion Buspirone Busulfan Butalbital Butoconazole Butorphanol Cabergoline Caffeine Calcitonin Calcitriol Calfactant Canakinumab Candesartan Capecitabine
U ND No (NS) Yes (NS) No (NS) ND U Yes (NS) No (NS) U ND U No (NS) U U U No (NS) No (NS) Yes (NS) ND U U ND ND U No (4.2-5.3) ND U No (NS) ND
ND ND ND ND ND ND No (11.1) L U ND ND U No (20) U U U No (10) ND Yes (8.1) ND U ND ND ND U No (31) ND U No (8.1) ND
U ND ND ND No ND U ND U U ND U U U U U No ND ND ND U U ND ND U U ND U ND ND
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Drug
Capreomycin Captopril Carbamazepine Carbenicillin Carbidopa/levodopa Carbinoxamine Carboplatin Carboprost Carisoprodol Carmustine Carprofen Carteolol Carumonam Carvedilol Caspofungin Cefaclor Cefadroxil Cefamandole Cefazolin Cefdinir Cefditoren Cefepime Cexime Cefmenoxime Cefmetazole Cefodizime Cefonicid Cefoperazone Ceforanide Cefotaxime
22
Yes (NS) Yes (NS) No (NS) Yes (NS) ND/U ND Yes (NS) ND Yes (NS) No (NS) U ND Yes (NS) No (NS) No (NS) Yes (NS) Yes (NS) Yes (NS) Yes (6, 8) ND No (NS) Yes (NS) No (NS) Yes (NS) Yes (NS) No (NS) No (NS) No (NS) Yes (NS) Yes (NS)
L L Yes (22, 55) L ND/U ND L ND L ND U ND L U U L L L Yes (8.1-60) Yes (NS) ND Yes (40, 60) ND L L ND ND ND L L
ND No No No ND/U ND No ND Yes ND U ND ND U U Yes No No No ND ND Yes No ND No No No No No No
I CHART
Drug
Cefoxitin Cefpirome Cefpodoxime Cefprozil Cefroxadine Cefsulodin Ceftazidime Ceftibuten Ceftizoxime Ceftobiprole Ceftriaxone Cefuroxime Celecoxib Cephalexin Cephalothin Cephapirin Cephradine Certolizumab Cetirizine Cetrorelix Cetuximab Cevimeline Chloral hydrate Chlorambucil Chloramphenicol Chlordiazepoxide Chloroquine Chlorothiazide Chlorpheniramine Chlorpromazine
Yes (NS) Yes (NS) Yes (NS) Yes (NS) ND Yes (NS) Yes (NS) Yes (NS) Yes (NS) ND No (NS) Yes (NS) U Yes (NS) Yes (NS) Yes (NS) Yes (NS) U U ND No (NS) ND Yes (5.5) No (NS) Yes (NS) No (NS) No (NS) No (NS) Yes (NS) No (NS)
L Yes (40) L L ND L L L L ND ND L U L L L L U No (18.7-66.7) ND U ND L ND L U ND ND L U
No No No ND ND Yes Yes ND No ND No No U No No No Yes U U ND U ND ND No No U No U No No

23
Drug
Chlorpropamide Chlorprothixene Chlorthalidone Chlorzoxazone Cholecalciferol Cholestyramine Choriogonadotropin Ciclesonide Cidofovir Cilastatin Cilazapril Cilostazol Cimetidine Cinacalcet Cinoxacin Ciprooxacin Cisapride Cisatracurium Cisplatin Citalopram Cladribine Clarithromycin Clavulanic acid Clemastine Clevidipine Clinaoxacin Clindamycin Clodronate Clofarabine Clofazimine
24
No* (NS) U No (NS) ND U U U U ND Yes (NS) Yes (NS) U No (NS) No (NS) No (NS) No (NS) No (NS) U No (NS) No (8) ND ND Yes (NS) U U No (6.4) No (NS) ND ND No (NS)
ND ND ND ND U U U U Yes (60) L L U ND U ND ND U ND Yes (NS) No (40) ND ND L U U No (8.1, 8.8) ND Yes (8.1) ND ND
No U U ND U U U U No ND ND U No No U No U U ND U ND ND Yes U U ND No No ND No
I CHART
Drug
Clobrate Clomiphene Clomipramine Clonazepam Clonidine Clopidogrel Clorazepate Clotrimazole Cloxacillin Clozapine Codeine Colchicine Colesevalam Colestipol Colistin Conivaptan Cortisone Cromolyn sodium Cyanocobalamin Cyclacillin Cyclobenzaprine Cyclophosphamide Cycloserine Cyclosporine Cyproheptadine Cystadane Cysteamine Cytarabine Dabigatran Dacarbazine
No (NS) ND U No (NS) No (NS) U No (NS) U No (NS) U No (NS) No (NS) U U No (NS) U No (NS) U No (NS) Yes (NS) U Yes (6.4) ND No (NS) ND ND ND ND ND ND
U ND U ND ND ND ND U ND U ND ND U U ND U ND U No (40, 65) L U L Yes (30, 52) U ND ND ND Yes (NS) ND ND
No ND U U No U U U No U U No U U No U No U ND No U ND ND No ND ND No No ND ND
25
Drug
Daclizumab Dactinomycin Dalbavancin Dalteparin Danaparoid Dantrolene Dapsone Daptomycin Darbepoetin alfa Darifenacin Darunavir Dasatinib Daunorubicin Decitabine Deferasirox Deferoxamine Deazacort Degarelix Delavirdine Demeclocycline Denileukin Desipramine Desloratadine Desmopressin Desogestrel Desvenlafaxine Dexamethasone Dexchlorpheniramine Dexfenuramine Dexmedetomidine
26
U ND No (NS) U ND ND Yes (NS) No (NS) U U U U ND ND U Yes (NS) No (NS) U U ND U No (NS) No (NS) ND U No (NS) No (NS) Yes (NS) ND U
ND ND ND ND ND ND L U No (11.1-55) U U U ND ND U L ND U ND ND U ND ND ND U U ND L ND U
U ND U U ND ND ND No U U U U ND ND U ND U U U ND U No No ND U U No No ND U
I CHART
Drug
Dexmethylphenidate Dexrazoxane Dextroamphetamine Dezocine Diatrizoate Diazepam Diazoxide Dibekacin Diclofenac Dicloxacillin Dicyclomine Didanosine Diethylpropion Diethylstilbesterol (fosfestrol) Diunisal Digitoxin Digoxin Digoxin immune Fab Dihydrocodeine Dihydroergotamine Diltiazem Dimenhydrinate Dimyristoyl lecithin Dinoprostone Diphenhydramine Diphenoxylate/ Atropine Dipyridamole Dirithromycin
ND ND ND ND L No (NS) Yes (NS) Yes (NS) U No (NS) ND No (7.9) ND No (NS) No (NS) No (NS) No (NS) No (NS) ND ND No (NS) ND ND ND U ND U No (NS)
ND ND ND ND Yes (NS) ND L L ND ND ND No (40) ND ND ND ND ND U ND ND ND ND ND ND ND ND ND ND
ND ND ND ND ND U Yes ND U No ND No ND ND U No No No ND ND No ND ND ND U ND ND No
27
Drug
Disopyramide Disulram Divalproex Dobutamine Docetaxel Dofetilide Dolasetron Domperidone Donepezil Dopamine Doripenem Dornase alfa Doxacurium Doxapram Doxazosin Doxepin Doxercalciferol Doxorubicin Doxycycline Doxylamine Dronabinol Dronedarone Droperidol Drosperinone Drotrecogin alfa Duloxetine Dutasteride Eculizumab Edetate calcium (ETDA)
28
No (NS) U No (NS) No (NS) No (NS) ND ND U U No (NS) Yes (NS) U No (NS) ND No (NS) No (NS) No (NS) No (NS) No (NS) ND U U U U U U U U Yes (NS)
U U ND ND U ND ND U ND ND ND U ND ND ND ND U ND ND ND ND U ND U U U U U L
U U No No U ND ND U U U ND U U ND No No U ND No ND U U U U U U U U Yes
I CHART
Drug
Edrophonium Efalizumab Efavirenz Eletriptan Eltrombopag Emtricitabine Enalapril (enalaprilat) Encainide Enfuvirtide Enoxacin Enoxaparin Entacapone Entecavir Enfuvirtide Ephedrine Epinephrine Epirubicin Eplerenone Epoetin alfa Epoprostenol Eprosartan Eptacog alfa Eptibatide Ergocalciferol Ergotamine Erlotinib Ertapenem Erythromycin Escitalopram Eslicarbazine
ND U No (NS) ND ND Yes (NS) Yes (NS) No (NS) No (NS) No (NS) No (NS) U No (NS) No (NS) ND ND ND No (7) No (NS) ND U U ND ND ND U Yes (NS) No (NS) ND Yes (NS)
ND U ND ND ND ND L ND U ND Yes (11.5-55) U ND U ND ND ND ND No (11.1-55) ND No (60) U ND ND ND U L ND ND L
ND U No ND ND ND Yes ND U No No U No U ND ND ND ND No ND U U ND ND ND U ND No ND ND
29
Drug
Esmolol (ASL-8123) Esomeprazole Estazolam Estradiol Estramustine Estrogens, conjugated Estrone Estropipate Eszopiclone Etanercept Ethacrynic acid Ethambutol Ethanolamine oleate Ethchlorvynol Ethinyl estradiol Ethionamide Ethosuximide Ethotoin Etidronate Etodolac Etonogestrel Etoposide Etoricoxib Etravirine Everolimus Exemestane Exenatide Ezetimibe Famciclovir (penciclovir)
30
Yes (NS) U U No (NS) ND ND No (NS) U ND No (NS) No (NS) No (NS) ND No* (NS) U U Yes (NS) ND ND No (NS) ND No (NS) No (NS) U ND U ND U Yes (NS)
L U U U ND ND ND U ND U U No (80) ND ND U No (30, 52) L ND ND U ND No (NS) U U ND U ND U L
Yes U U U ND ND ND U ND U U U ND No No U ND ND ND U ND No U U ND U ND U ND
I CHART
Drug
Famotidine Febuxostat Felbamate Felodipine Fenuramine Fenobrate Fenoldopam Fenoprofen Fentanyl Ferric gluconate Ferrous (iron) salts Ferumoxytol Fesoterodine Fexofenadine Filgrastim Finasteride Flavoxate Flecainide Fleroxacin Floxuridine Fluconazole Flucytosine Fludarabine Fludrocortisone Flumazenil Fluorouracil/FBAL Fluoxetine Fluoxymesterone Fluphenazine Flurazepam
No (NS) ND U U ND ND No (NS) U ND ND No (NS) U U ND No (NS) U U No (10.1) No (NS) ND U ND No (NS) ND ND ND No (NS) ND No (NS) ND U ND ND ND No (NS) ND U No (8.1, 22) ND ND Yes (NS) L Yes (NS) L ND ND ND ND ND ND No (NS)/ND No (40)/Yes (40) No (NS) U ND ND U ND No (NS) ND
No U ND U ND U No U ND U U ND ND U U U ND U No ND Yes Yes ND ND ND ND No ND U U
31
Drug
Flurbiprofen Flutamide Fluticasone Fluvastatin Fluvoxamine Folic acid Follitropin alfa Follitropin beta Fomepizole Fondaparinux Fosamprenavir Fosaprepitant Foscarnet Fosfomycin Fosinopril (fosinoprilat) Fosphenytoin Frovatriptan Fulvestrant Furosemide Fusidic acid Gabapentin Gadobenate Gadobutrol Gadodiamide Gadolinium Gadopentetate Gadoteridol Gadoversetamide Gadoxetate Galantamine
32
U No (NS) U No (NS) U Yes (NS) ND ND Yes (NS) No (NS) U No (NS) Yes (4.1) Yes (NS) No (NS) U ND U No (NS) No (NS) Yes (NS) ND Yes (5.5) Yes (NS) Yes (NS) Yes (NS) ND ND Yes (NS) ND
U ND U U No (NS) L ND ND L ND U U Yes (18-60) L ND U ND U U ND L ND L L ND L ND Yes (NS) L ND
No U U U U ND ND ND ND U U U ND ND No U ND U U No ND ND ND No ND ND ND ND ND ND
I CHART
Drug
Gallium Gallopamil Galsulfase Ganciclovir Ganirelix Garenoxacin Gatioxacin Geftinib Gemcitabine Gembrozil Gemioxacin Gemtuzumab Gentamicin Gestodene Glatiramer Gliclazide Glimepiride Glipizide Glucagon Glutethimide Glyburide Glycopyrrolate Gold sodium thiomalate Golimumab Goserelin Granisetron Grepaoxacin Griseofulvin Guaifenesin
ND U U Yes (NS) ND No (NS) ND U Yes (7) No (NS) No (NS) U Yes (NS) U ND U U U U No* (NS) No (NS) ND No (NS) U ND ND ND ND ND
ND U U L ND ND ND No (20) Yes (53, 58) U ND U Yes (13.2-60) U ND U U U ND ND U ND ND U ND ND ND ND ND
ND U U ND ND No ND U ND No ND U Yes U ND U U U U No U ND U U ND ND ND ND ND
33
Drug
Guanabenz U Guanadrel ND Guanethidine ND Guanfacine No (NS) Guanidine ND Halofantrine ND Haloperidol No (NS) Heparin No (NS) Hexobarbital No (NS) Hirudin No (4.3-6.5) Hydralazine No (NS) Hydrochlorothiazide No (NS) Hydrocodone ND Hydrocortisone U Hydromorphone No (NS) Hydroxychloroquine ND Hydroxyurea No (NS) Hydroxyzine No (NS) Ibandronate ND Ibritumomab U Ibuprofen No (NS) Ibutilide ND Idarubicin U Idebenone U Idursulfase U Ifosfamide Yes (1.6) Iloperidone U Iloprost ND Imatinib No (NS) Imidapril (imidaprilat) No (NS)
34
U ND ND ND ND ND U ND ND Yes (20-90) ND ND ND ND ND ND ND U Yes (8.1) U U ND U U U L U ND U U
U ND ND No ND ND No No U ND No U ND U U ND U No ND U U ND U U U ND U ND U U
I CHART
Drug
Imiglucerase Imipenem Imipramine Immune globulin Indapamide Indinavir Indomethacin Iniximab Insulin Insulin aspart Insulin detemir Insulin glargine Insulin glulisine Insulin lispro Interferons Iobenguane Iodipamide Iodixanol Iohexol Iomeprol Iopamidol Iopromide Iotrolan Ioversol Ioxaglic acid Ioxilan Ioxitalamic acid Irbesartan Irinotecan (SN-38 metabolite)
U Yes (NS) No (NS) U No (NS) U No (NS) U No (NS) U No (NS) U U U No (NS) No (NS) ND Yes (3.1, 4.2) Yes (NS) Yes (6.8) Yes (4.8) Yes (5.5-6.8) Yes (NS) Yes (6.3) L Yes (NS) ND No (NS) U/U
U L U ND ND No (40) U U ND ND U ND ND ND Yes (20-33) ND ND L Yes (15.5) L L Yes (8.1-62) L L Yes (15.5) L ND ND No (8.5)/ No (8.5)
U Yes No U U ND U U No U ND U ND U No ND ND ND ND Yes Yes ND ND ND ND ND ND ND U/U
35
Drug
Iron dextran Iron sucrose Isocarboxazid Isoniazid Isoproterenol Isosorbide dinitrate Isosorbide mononitrate Isotretinoin Isradipine Itraconazole Ivermectin Ixabepilone Kanamycin Ketamine Ketoconazole Ketoprofen Ketorolac Ketotifen Labetolol Lacosamide Lactulose Lamivudine Lamotrigine Lanreotide Lansoprazole Lanthanum carbonate Lapatinib Laronidase Leunomide Lenalidomide
36
U U ND No (NS) ND No (NS) Yes (NS) U No (NS) No (NS) ND ND Yes (NS) No (NS) No (NS) U U ND No (NS) No (NS) U No (NS) No (NS) ND No (NS) No (NS) U U No (NS) Yes (NS)
No (8.1-10.1) No (11.1-55) ND No (80) ND ND L U U No (65) ND ND L ND ND U U ND ND ND U No (11.4) ND ND U U U U No (8.1) ND
U U ND No ND No No U No U ND ND Yes U No U U ND No U U No U ND U U U U No ND
I CHART
Drug
Lepirudin Letrozole Leucovorin Leuprolide Levamisole Levetiracetam Levobupivacaine Levocarnitine Levocetirizine Levodopa Levooxacin Levoleucovorin Levomethadyl Levonorgestrel Levorphanol Levosimendan Levothyroxine Lidocaine Lincomycin Linezolid Liothyronine Lisdexamfetamine Lisinopril Lithium Lomeoxacin Lomustine Loperamide Lopinavir Loracarbef Loratadine
No (4.3-6.2) ND ND ND ND Yes (NS) U Yes (NS) No (NS) U U ND U U ND No (6.4) U No (NS) No (NS) Yes (NS) ND ND Yes (NS) Yes (NS) No (NS) No (NS) ND U Yes (NS) No (NS)
Yes (20-90) ND ND ND ND L ND L U U No (13.2) ND U ND ND U ND ND ND Yes (9.3-65) ND ND L Yes (40, 70) ND ND ND No (NS) L U
ND ND ND ND ND ND U ND U U No ND U U ND U U U No ND ND ND ND Yes No U ND U ND No
37
Drug
Lorazepam No (NS) ND Losartan No (NS) No (10.1-52) Lovastatin U U Loxapine ND ND L-tryptophan U No (8.1-40) Lubiprostone U U Lumefantrine ND ND Mangafodipir ND ND Mannitol Yes (NS) L Maprotiline No (NS) U Maraviroc ND ND Mecamylamine ND ND Mecasermin ND ND Mechlorethamine U U Meclofenamate U U Medroxyprogesterone U U Mefenamic acid No (NS) U Meoquine U ND Megestrol acetate ND ND Meloxicam No (NS) U Melphalan No (NS) ND Memantine ND ND Menadiol ND ND Menotropins ND ND Mepenzolate ND ND Meperidine/ No (NS)/ND No (8.1)/Yes (8.1) normeperidine Meprobamate Yes (NS) L Mercaptopurine Yes (NS) L Meropenem Yes (NS) L
38
U No U ND ND U ND ND Yes U ND ND ND U U U U U ND U ND ND ND ND ND U/ND Yes ND ND
I CHART
Drug
Mesalamine (5-ASA) Mesna Mesoridazine Metaproterenol Metaxalone Metformin Methadone Methaqualone Methenamine Methicillin Methimazole Methocarbamol Methohexital Methotrexate Methoxsalen Methoxypolyethylene glycol-epoetin beta Methscopolamine Methsuximide Methyldopa Methylergonovine Methylnaltrexone Methylphenidate Methylprednisolone Methysergide Metoclopramide Metolazone Metoprolol Metronidazole Mexiletine
Yes (5.5) ND U ND ND Yes (NS) No (NS) No (NS) ND No (NS) No (NS) ND U Yes (NS) ND U ND ND Yes (NS) ND ND U Yes (NS) ND No (NS) No (NS) Yes (NS) Yes (NS) Yes (NS)
ND ND ND ND ND L U ND ND U ND ND U Yes (20, 60) ND U ND ND L ND ND ND L ND U U L Yes (56) L
U ND U ND ND ND No No ND No No ND U No ND U ND ND Yes ND ND U ND ND No U ND No No
39
Drug
Mezlocillin Micafungin Miconazole Midazolam Midodrine (de-glymidodrine) Mifepristone Miglitol Miglustat Milnacipran Milrinone Minocycline Minoxidil Mirtazapine Misoprostol Mitomycin Mitotane Mitoxantrone Mivacurium Modanil Moexipril Molindone Montelukast Moricizine Moroctocog alfa Morphine Moxioxacin Muromonab-CD3 Mycophenolate (mycophenolic acid)
40
Yes (NS) U No (NS) No (NS) ND U ND ND U ND No (NS) Yes (NS) No (7.5) U ND ND No (NS) ND ND ND U U U U ND ND U No (NS)
L U U U Yes (8.1) U ND ND U ND ND L ND ND ND ND U ND ND ND ND ND ND U Yes (8.1, 10.1) ND ND U
No U No U ND U ND ND U ND No Yes U U ND ND No ND ND ND U U U U No ND U No
I CHART
Drug
Nabilone Nabumetone Nadolol Nadroparin Nafarelin Nafcillin Nalbuphine Nalidixic acid Nalmefene Naloxone Naltrexone Nandrolone Naproxen Naratriptan Natalizumab Nateglinide/ M1 metabolite Nebivolol Nedocromil Nefazodone Nelarabine Nelnavir Neomycin Nesiritide Netilmicin Nevirapine Niacin Niacinamide Nicardipine Nicotine
ND No (NS) Yes (NS) ND ND No (NS) ND U No (4.1-5.9) ND No (NS) ND No (NS) ND U U/Yes (NS) U ND U U U Yes (NS) U Yes (NS) ND ND ND No (NS) ND
ND U L ND ND ND ND U U ND U ND U ND U U/Yes (NS) U ND U U No (71) L U L Yes (40) ND ND U ND
ND U ND ND ND No ND U U ND U ND U ND U U/ND U ND U U No Yes U Yes Yes ND ND U ND

41
Drug
Nicotinic acid Nifedipine Nilotinib Nilutamide Nimodipine Nisoldipine Nitazoxanide Nitrendipine Nitrofurantoin Nitroglycerin Nitroprusside Nizatidine Nomifensine Nonacog alfa Norepinephrine Norethindrone Noroxacin Norgestimate Norgestrel Nortriptyline Nylidrin Nystatin Octreotide Ooxacin Olanzapine Olmesartan Olsalazine Omapatrilat Omega-3-acid ethyl esters
42
ND No (NS) U ND No (NS) No (NS) U No (NS) Yes (NS) No (NS) Yes (NS) No (NS) ND U ND ND No (NS) U ND No (NS) ND U Yes (NS) Yes (6.0) No (NS) U U No (NS) ND
ND U U ND U U U U L ND L ND ND U ND ND ND U ND U ND U L Yes (8.5) U No (NS) ND ND ND
ND No U ND No No U U ND No Yes No ND U ND No U U ND No ND U ND No No U U ND ND
I CHART
Drug
Omeprazole Ondansetron Oprelvekin Orboban Orlistat Ornidazole Orphenadrine Oseltamivir Oxacillin Oxaliplatin Oxandrolone Oxaprozin Oxazepam Oxcarbazepine Oxtriphylline Oxybutynin Oxycodone Oxymetholone Oxymorphone Paclitaxel Palifermin Paliperidone Palivizumab Palonosetron Pamidronate Pancuronium Panitumumab Pantoprazole Papaverine Para-aminosalicylate
U U U Yes (NS) U Yes (NS) ND Yes (NS) No (NS) ND U No (NS) No (NS) ND Yes (NS) ND ND ND U No (NS) U ND U ND Yes (6.4) ND U No (5.1) U U
ND ND U L U L ND ND U ND U ND ND ND L ND Yes (48) ND U U ND ND U ND L ND U U U No (30, 60)
U U U ND U No ND Yes No ND U U U ND No ND ND ND U No ND ND U ND ND ND U U U U
43
Drug
Paricalcitol Paromomycin Paroxetine Peoxacin Pegademase Pegaspargase Peglgrastim Peginterferon alfa-2a Peginterferon alfa-2b Pegvisomant Pemetrexed Pemoline Penbutolol Penicillamine Penicillin Pentamidine Pentazocine Pentobarbital Pentosan polysulfate Pentostatin Pentoxifylline Perexane Perutren Pergolide Perindopril (perindoprilat) Perphenazine Phenacetin Phenazopyridine
44
No (5.5) ND No (NS) No (NS) U U No (NS) U U U ND Yes (NS) No (NS) Yes (NS) Yes (NS) No (NS) Yes (NS) No (NS) ND ND U ND ND U Yes (NS) U ND ND
ND ND U ND U ND U No (8.7-33) No (8.7) Yes (20-33) U ND L ND L L ND L ND ND ND U ND ND U L U ND ND
ND ND U No U U U U U U ND No No ND No No ND U ND ND U ND ND U ND U ND ND
I CHART
Drug
Phendimetrazine Phenelzine Phenobarbital Phenoxybenzamine Phentermine Phentolamine Phenylbutazone Phenytoin Phytonadione Pilocarpine Pimozide Pinaverium Pindolol Pioglitazone Piperacillin Piroxicam Pizotyline Plerixafor Plicamycin Polyethylene glycol Polythiazide Poractant alfa Pormer Posaconazole Pralidoxime Pramipexole Pramlintide Prasugrel Pravastatin Prazepam
ND ND Yes (NS) ND ND ND No (NS) No (NS) ND ND ND U ND U Yes (NS) U U ND ND U No (NS) ND No (NS) No (NS) ND No (NS) ND U No (5.3) No (NS)
ND ND Yes (60) ND ND ND U Yes (36) ND ND ND U ND U L U U ND ND U ND ND U U ND U ND U ND ND
ND ND Yes ND ND ND U No ND ND ND U ND U No U U ND ND U No ND U U ND U ND U ND U
45
Drug
Praziquantel No (NS) Prazosin No (NS) Prednisolone U Prednisone No (NS) Pregabalin Yes (NS) Primaquine No (NS) Primidone Yes (NS) Probenecid U Probucol No (NS) Procainamide/N-acetyl Yes (NS)/ procainamide (NAPA) Yes (NS) Procarbazine ND Prochlorperazine U Procyclidine ND Progesterone U Proguanil No (NS) Promazine U Promethazine No (NS) Propafenone No (NS) Propantheline ND Propofol U Propoxyphene No (NS) Propranolol No (NS) Propylthiouracil No (NS) Protriptyline No (NS) Pseudoephedrine No (NS) Pyrantel ND Pyrazinamide Yes (NS) Pyridostigmine ND Pyridoxine ND
46
ND U No (NS) ND L U L U ND L/L ND U ND U U ND U U ND U ND U ND U U ND Yes (80) ND Yes (36)
ND No U No ND U ND U No No/No ND U ND U U U U No ND U No No ND No U ND No ND ND
I CHART
Drug
Pyrilamine Pyrimethamine Quazepam Quetiapine Quinapril (quinaprilat) Quinidine Quinine Quinupristin/ dalfopristin Rabeprazole Raloxifene Raltegravir Raltitrexed Ramelteon Ramipril (ramiprilat) Ranibizumab Ranitidine Ranolazine Rapacuronium Rasagiline Rasburicase Recainam Remifentanil Repaglinide Reserpine Reteplase Reviparin Ribavirin Rifabutin Rifampin
ND ND U ND No (NS) No* (NS) No (NS) ND U U ND ND ND No (NS) U No (NS) ND ND ND U No (NS) U U No (NS) ND No (NS) No (NS) U No (NS)
ND ND U ND U U U ND U U ND ND ND ND U Yes (NS) ND ND ND U ND U No (60) U ND ND U No (40) No (80)
ND ND U ND No No No No/No U U ND ND ND ND U No ND ND ND U U U U No ND U U U No
47
Drug
Rifapentine Rifaximin Rilmenidine Rilonacept Riluzole Rimantadine Risedronate Risperidone Ritodrine Ritonavir Rituximab Rivastigmine Rizatriptan Rocuronium Romiplostim Ropinirole Ropivacaine Rosiglitazone Rosuvastatin Rotigotine Roxithromycin Ruboxistaurin Runamide Ruoxacin Sacrosidase Salsalate Sapropterin Saquinavir Sargramostim Secobarbital
48
U U No (NS) U U No (NS) ND ND Yes (NS) U No (NS) ND ND ND ND U U No (NS) No (NS) U ND U No (NS) ND ND Yes (NS) ND U ND No (NS)
U U ND U U U ND ND L No (40) U ND ND ND ND U U U ND U ND U ND ND ND L ND No (40) ND ND
U U U U U U ND ND Yes No U ND ND ND ND U U No U U No U U ND ND No ND U ND No
I CHART
Drug
Secretin Selegiline Sermorelin Sertindole Sertraline Sevelamer Sevourane Sibutramine Sildenal Silodosin Silver Simethicone Simvastatin Sirolimus Sisomicin Sitagliptin Sitaxsentan Sodium oxybate Sodium polystyrene sulfonate Solifenacin Somatropin Sorafenib Sotalol Sparoxacin Spectinomycin Spirapril (spiraprilat) Spironolactone Stanozolol Stavudine
ND ND ND No (NS) No (NS) U ND U U U No (NS) U U No (NS) Yes (NS) No (NS) U ND U U No (NS) U Yes (NS) ND Yes (NS) U U ND Yes (NS)
ND ND ND U U U ND U No (65) U ND U U U L ND U ND U U U U L ND L ND ND ND Yes (NS)
ND ND ND U U U ND U U U U U U U ND ND U ND U U U U ND ND Yes U U ND ND
49
Drug
Streptokinase Streptomycin Sucralfate Sufentanil Sulbactam Sulfadiazine Sulfadoxine Sulfamethoxazole Sulfapyridine Sulfasalazine Sulnpyrazone Sulsoxazole Sulindac Sumatriptan Sunitinib Tacrine Tacrolimus Tadalal Talinolol Tamoxifen Tamsulosin Tapentadol Tazobactam Tebazumab Tegaserod Teicoplanin Telbivudine Telithromycin Telmisartan Temazepam
50
U Yes (NS) No (NS) U Yes (NS) ND ND Yes (NS) ND U No (NS) Yes (NS) No (NS) ND U ND No (NS) No (NS) No (NS) ND U U Yes (NS) No (NS) No (NS) No (NS) No (NS) ND No (NS) No (NS)
U L ND U L ND ND L ND U U L ND ND No (NS) ND U U ND ND U U L ND U ND ND ND ND U
U Yes No U No ND ND No ND U U Yes U ND U ND U U ND ND U U No U U No ND ND U U
I CHART
Drug
Temocillin Temozolomide Temsirolimus Teniposide Tenofovir Terazosin Terbinane Terbutaline Teriparatide Testolactone Testosterone Tetrabenazine Tetracycline Thalidomide Thallous chloride Theophylline Thiabendazole Thiamine Thiethylperazine Thioguanine Thioproperazine Thioridazine Thiotepa Thiothixene Thyrotropin alfa Tiagabine Ticarcillin Ticlopidine Tigecycline Tilidine
Yes (NS) ND No (NS) U ND No (NS) U ND ND ND No (NS) ND No (NS) U ND Yes (NS) ND No (NS) ND ND ND U ND U U No (NS) Yes (NS) U No (NS) No (NS)
L ND U ND Yes (50) U U ND ND ND U ND ND No (65) ND L ND ND ND ND ND U ND ND U U L U ND ND
No ND U U ND No U ND ND ND U ND No U ND No ND U ND ND ND U ND U U U No U U U
51
Drug
Tiludronate Timolol Tinidazole Tinzaparin Tipranavir Tiroban Tizanidine Tobramycin Tocainide Tocopherol Tolazamide Tolbutamide Tolcapone Tolmetin Tolterodine Tolvaptan Topiramate Topotecan Torsemide Tositumomab Tosuoxacin Tramadol Trandolapril (trandolaprilat) Tranexamic acid Tranylcypromine Trapidil Trastuzumab Trazodone Treprostinil
52
U No (NS) Yes (NS) U U Yes (NS) ND Yes (NS) Yes (NS) ND U No (NS) U U U U Yes (NS) Yes (8.0) No (NS) U No (NS) No (NS) Yes (NS) ND ND ND U U U
ND ND L ND U L ND L L ND ND ND U U U U L L U U ND Yes (50) L ND ND ND U ND U
U No ND ND U ND ND Yes ND ND U U U U U U ND ND U U ND ND ND ND ND ND U U U
I CHART
Drug
Tretinoin Triamterene Triazolam Trientine Triuoperazine Triupromazine Trihexyphenidyl Trimeprazine Trimethobenzamide Trimethoprim Trimetrexate Trimipramine Triprolidine Triptorelin Tropisetron Trospium Trovaoxacin Urofollitropin Ursodiol Valacyclovir Valganciclovir Valproic acid Valrubicin Valsartan Vancomycin Vardenal Varenicline Vecuronium Velosulin Venlafaxine
ND ND No (NS) ND No (NS) U ND ND ND Yes (NS) U U ND ND U ND No (NS) ND U Yes (NS) Yes (NS) No (NS) ND No (NS) No (NS) ND Yes (NS) U U No (NS)
ND ND ND ND U ND ND ND ND L U U ND ND U ND ND ND U L ND Yes (62) ND ND Yes (10.1-60) ND ND ND U U
ND ND U ND No U ND ND ND No U U ND ND U ND ND ND U No ND No ND U No ND ND U U U
53
Drug
Verapamil Verteporn Vigabatrin Vinblastine Vincristine Vinorelbine Voriconazole Vorinostat Warfarin Zarlukast Zalcitabine Zaleplon Zanamivir Zidovudine/GZDV Zileuton Zinc Ziprasidone Zoledronic acid Zolmitriptan Zolpidem Zonisamide Zuclopenthixol
No (NS) ND Yes (NS) ND ND ND No (NS) ND No (NS) U ND ND ND No (NS)/ Yes (NS) U ND No (NS) ND U No (NS) Yes (NS) ND
ND ND L ND ND ND U ND ND U ND ND ND ND/L No (8.3, 10.1) ND U ND U U ND ND
No ND ND ND ND ND No ND No U ND ND ND No/Yes U ND U ND U U ND ND
54
I CHART
Drugs of Abuse
Drug
Amphetamine Cocaine Ethanol Heroin Lysergide (LSD) Marijuana (THC) MDMA (Ecstasy) Mescaline (peyote) Nicotine Phencyclidine (PCP) Psilocybin
ND No (NS) Yes (NS) U U U ND U ND U ND
ND ND L ND ND ND ND ND ND ND ND
ND U ND U U U ND U No U ND
55
References
1. Aronoff GR, Bennett WM, Berns JS, Brier ME, Kasbekar N, Mueller BA, Pasko DA, Smoyer WE. Drug prescribing in renal failure, 5th ed. Philadelphia: American College of Physicians; 2007. 2. Choi G, Gomersall CD, Tian Q, Joynt GM, Freebairn R, Lipman J. Principles of antibacterial dosing in continuous renal replacement therapy. Crit Care Med. 2009;37:2268-2282. 3. Schetz M. Drug dosing in continuous renal replacement therapy: general rules. Curr Opin Crit Care. 2007;13:645-651. 4. Heintz BH, Matzke GR, Dager WE. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis. Pharmacotherapy. 2009;29:562-577. 5. Ibrahim RB, Liu C, Cronin SM, Murphy BD, Cha R, Swerdlow P, Edwards DJ. Drug removal by plasmapheresis: an evidence-based review. Pharmacotherapy. 2007;27:1529-1549. 6. Keller E, Reetze P, Schollmeyer P. Drug therapy in patients undergoing continuous ambulatory peritoneal dialysis: Clinical pharmacokinetic considerations. Clin Pharmacokinet. 1990;18:104-117. 7. Keller F, Bhler J, Czock D, Zellner D, Mertz AKH. Individualized drug dosage in patients treated with continuous hemoltration. Kidney Int. 1999;56 (Suppl 72):S-29- S31. 8. Bugge JF. Pharmacokinetics and drug dosing adjustments during continuous venovenous hemoltration or hemodialtration in critically ill patients. Acta Anaesthesiol Scand. 2001;45:929-934. 9. Olyaei AJ, Bennett WM. Principles of drug usage in dialysis patients, in Nissenson AR, Fine RN (eds). Handbook of Dialysis Therapy (4th ed). Philadelphia: Saunders Elsevier; 2008. 10. Taylor CA, Abdel-Rahman E, Zimmerman SW, Johnson CA. Clinical pharmacokinetics during continuous ambulatory peritoneal dialysis. Clin Pharmacokinet. 1996;31:293-308.
56

Dialysis Drugs 2010

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Dialysis Drugs 2010

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2010 Dialysis of Drugs

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

What Determines Drug Dialyzability?

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

Blood and Dialysate Flow Rates

2010 Dialysis of Drugs

2010 Dialysis of Drugs

Drug Name Cefuroxime Clindamycin Digoxin

Erythromycin Gentamicin Metronidazole Mezlocillin N-acetylprocainamide Nafcillin Oxacillin Phenobarbital Phenytoin

0.30 0.95 0.80 0.68 0.90 0.20 0.05 0.60 0.10

0.86 0.85 0.93 0.78

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

Drug Name Tobramycin

2010 Dialysis of Drugs

About This Guide

I ABOUT THIS GUIDE

2010 Dialysis of Drugs

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

L ND ND ND No (11.1) ND ND ND ND ND U ND ND L ND ND L L U ND U U L ND No (10.1, 36) ND L ND ND

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

U ND ND ND U U ND ND ND U U ND ND No (10.7-36) U ND ND ND ND Yes (8.8) ND L U L U U

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2010 Dialysis of Drugs

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

ND ND ND ND ND L U ND L L Yes (60) U ND ND U ND ND ND ND ND U ND ND ND ND No (NS) U U Yes (NS)

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HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

ND ND ND ND ND ND No (11.1) L U ND ND U No (20) U U U No (10) ND Yes (8.1) ND U ND ND ND U No (31) ND U No (8.1) ND

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2010 Dialysis of Drugs

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

ND No No No ND/U ND No ND Yes ND U ND ND U U Yes No No No ND ND Yes No ND No No No No No No

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HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

L Yes (40) L L ND L L L L ND ND L U L L L L U No (18.7-66.7) ND U ND L ND L U ND ND L U

No No No ND ND Yes Yes ND No ND No No U No No No Yes U U ND U ND ND No No U No U No No

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2010 Dialysis of Drugs

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

ND ND ND ND U U U U Yes (60) L L U ND U ND ND U ND Yes (NS) No (40) ND ND L U U No (8.1, 8.8) ND Yes (8.1) ND ND

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HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

U ND U ND ND ND ND U ND U ND ND U U ND U ND U No (40, 65) L U L Yes (30, 52) U ND ND ND Yes (NS) ND ND

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2010 Dialysis of Drugs

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

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HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

ND ND ND ND Yes (NS) ND L L ND ND ND No (40) ND ND ND ND ND U ND ND ND ND ND ND ND ND ND ND

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2010 Dialysis of Drugs

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis