Documente Academic
Documente Profesional
Documente Cultură
EXCREIE
NEALTER
AT (%)
LEGARE
A DE
PROTEIN
E (%)
20-30
80-90
Celecoxib
Hepatic
97
Ibuprofen
<1
99
Rofecoxib
Hepatic
85
Antimicrobiene
Aminoglicozide (cu doze zilnice multiple)
Amikacina
95
<5
Gentamicina
95
<5
T N /
AFECTAR
E
RENAL
(H)
2/2
2-3/
neschimbat
11/
neschimbat
2/
neschimbat
17/
neschimbat
1,4-2,3/ 17150
1,8/ 20-60
AJUSTAREA DOZEI/FRECVENEI
ADMINISTRRII FUNCIE DE
RFG (ML/MIN)
DOZA
SUPLIMENTAR
PENTRU
RFG > 50
RFG 10-50
RFG < 10
HD
DIALIZ
PERITON
EAL
q4h
q4h
q6h
q4-6h
q8h
A se evita
Fr
Fr
A se evita
A se evita
Fr
Doza dup
HD
?
100%
100%
100%
Fr
Fr
25 mg qd
A se evita
A se evita
60-90%
q12h sau
100% q1224h
60-90% q812h sau
100% q12-
30-70%
q12-18h
sau 100%
q24-48h
30-70%
q12h sau
100% q24-
20-30%
q24-48h
sau 100%
q48-72h
20-30%
q24-48h
sau 100%
doza
total dup
HD
15-20
mg/L/zi
doza
total dup
HD
3-4 mg/L/zi
MEDICAMEN
TUL
EXCREIE
NEALTER
AT (%)
LEGARE
A DE
PROTEIN
E (%)
T N /
AFECTAR
E
RENAL
(H)
AJUSTAREA DOZEI/FRECVENEI
ADMINISTRRII FUNCIE DE
RFG (ML/MIN)
RFG > 50
RFG 10-50
RFG < 10
24h
q24h
48h
q24-72h
q48-72h
q27-96h
DOZA
SUPLIMENTAR
PENTRU
HD
DIALIZ
PERITON
EAL
doza
total
Doza
total
20-40
mg/L/zi
3-4 mg/L/zi
Streptomicina
70
35
2,5/100
Tobramicina
95
<5
2,5/ 27-60
60-90% q812h
30-70%
q12h
20-30%
q24-48h
Carbapenemi
Imipenem
20-70
13-21
1,0/4,0
100%
50%
25%
Doza dup
HD
50%
Cefalosporine
Cefaclor
70
25
1,0/3,0
100%
50-100%
50%
Cefazolin
75-95
80
2/ 40-70
q8h
q12h
q24-48h
250 mg q812h
0,5 g q12h
Cefotaxim
60
37
1,0/15
q6h
q8-12h
q24h
Ceftazidim
60-85
17
1,2/ 13-25
q8-12h
q24-48h
q24h
Ceftriaxona
30-65
90
7-9/ 12-24
100%
100%
100%
98
20
0,7/16
q8h
q12h
q12h
250 mg
dup HD
0,5-1,0 g
dup HD
1 g dup
HD
1 g dup
HD
Doza dup
HD
Doza dup
HD
Cefalexin
Macrolide
1g/zi
0,5 g/zi
750 mg
q12h
Doza pentru
RFG < 10
MEDICAMEN
TUL
EXCREIE
NEALTER
AT (%)
LEGARE
A DE
PROTEIN
E (%)
T N /
AFECTAR
E
RENAL
(H)
AJUSTAREA DOZEI/FRECVENEI
ADMINISTRRII FUNCIE DE
RFG (ML/MIN)
DOZA
SUPLIMENTAR
PENTRU
RFG > 50
RFG 10-50
RFG < 10
HD
Fr
Doza dup
HD
Fr
Azitromicina
Claritromicina
6-12
15
8,0-50,0
70
10-60/ ?
2,3-6,0/ ?
100%
100%
100%
75%
100%
50-70%
Eritromicina
Diverse
Clindamicina
Metronidazol
15
60-90
1,4/ 5-6
100%
100%
50-70%
10
20
60-95
20
2-4/3-5
6-14/ 7-21
100%
100%
100%
100%
100%
50%
Sulfametoxazol
70
50
10/ 20-50
q12h
q18h
q24h
Trimetoprim
40-70
30-70
9-13/ 20-49
q12h
q18h
q24h
Vancomicina
90-100
10-50
6-8/ 200
500 mg
q12h
500 mg
q24-48h
500 mg
q48-96h
Peniciline
Amoxicilina
50-70
15-25
2,3/ 5-20
q8h
q8-12h
q24h
Ampicilina
30-70
20
1,5/ 7-20
q6h
q6-12h
q12-24h
Aztreonam
75
45-60
2,9/ 6-8
100%
50-75%
25%
Nafcilina
36
85
0,5/ 1,2
100%
100%
100%
DIALIZ
PERITON
EAL
Fr
Fr
Fr
Fr
Fr
Doza dup Doza pentru
HD
RFG < 10
1 g dup
1 g/zi
HD
Doza dup
HD
Doza pentru Doza pentru
RFG < 10
RFG < 10
Doza dup
HD
Doza dup
HD
0,5 g dup
HD
Fr
250 mg
q12h
250 mg
q12h
Doza pentru
RFG < 10
Fr
MEDICAMEN
TUL
EXCREIE
NEALTER
AT (%)
LEGARE
A DE
PROTEIN
E (%)
T N /
AFECTAR
E
RENAL
(H)
AJUSTAREA DOZEI/FRECVENEI
ADMINISTRRII FUNCIE DE
RFG (ML/MIN)
DOZA
SUPLIMENTAR
PENTRU
RFG > 50
RFG 10-50
RFG < 10
HD
Doza dup
HD
DIALIZ
PERITON
EAL
Doza pentru
RFG < 10
Penicilina G
60-85
<5
0,5/ 6-20
100%
75%
20-50%
Chinolone
Ciprofloxacin
50-70
20-40
3-6/ 6-9
100%
50-75%
50%
Levofloxacin
67-87
24-38
4-8/ 76
100%
500 mg
iniial apoi
250 mg
q24-48h
500 mg
iniial apoi
250 mg
q48h
35-45
80-90
20/ 18-25
100%
100%
100%
Fr
12
22/ ?
100%
100%
100%
97
Faza 9-11
h apoi 4050h/ fr
schimbare
100%
100%
100%
200 mg
dup HD
Fr
Doza pentru
RFG < 10
?
40
50-65
4/ 5-50 zile
100%
100%
50%
Fr
Fr
75-90
10-30
4-7/ 15
q24h
q24-36h
q48h
Doza dup
Doza pentru
Tetracicline
Doxicilina
Antifungice
Fluconazol
Capsofungin
Antiparazitare
Clorochina
Antituberculoase
Etambutol
250 mg
250 mg
q12h
q12h
Doza pentru Doza pentru
RFG < 10
RFG < 10
MEDICAMEN
TUL
EXCREIE
NEALTER
AT (%)
LEGARE
A DE
PROTEIN
E (%)
T N /
AFECTAR
E
RENAL
(H)
AJUSTAREA DOZEI/FRECVENEI
ADMINISTRRII FUNCIE DE
RFG (ML/MIN)
RFG > 50
RFG 10-50
RFG < 10
DOZA
SUPLIMENTAR
PENTRU
HD
DIALIZ
PERITON
EAL
RFG < 10
Doza pentru
RFG < 10
A se evita
Doza pentru
RFG < 10
100%
100%
50%
0,5
60-90
0,7-4,0/ 817
54/?
1,5/ 1,8-11
100%
100%
A se evita
50-100%
A se evita
50%
HD
Doza dup
HD
A se evita
Fr
40-70
15-30
2,1-3,5/ 19
5 mg/kg
q8h
5 mg/kg
q12h
5 mg/kg
q24h
Doza dup
HD
Doza pentru
RFG < 10
85
17
3/ prelungit
28 mg/kg
15 mg/kg
6 mg/kg
Ganciclovir
(prodrog =
valganciclovir)
Lamivudina
90-100
1-2%
3,6/ 30
q12h
q24-48h
q48-96h
Doza dup
HD
Doza dup
HD
Doza pentru
RFG < 10
Doza pentru
RFG < 10
68-71
36
5-7/ 15-35
100 mg q zi
100 mg q zi
10-40
30-60/?
100%
50%
Valaciclovir
(prodrog al
aciclovir)
<12%
13,5-18,0
2,5/3,3
1 g q8h
1 g q12-24h
0,5 g q24h
Doza dup
HD
Doza dup
HD
Doza dup
HD
Ribavirin
150 mg
q12h
100%
Izoniazida
5-30
4-30
Pirazinamida
Rifampicina
1-3
15-30
Antivirale
Aciclovir
(prodrog =
valaciclovir)
Foscarnet
Doza pentru
RFG < 10
Doza pentru
RFG < 10
MEDICAMEN
TUL
EXCREIE
NEALTER
AT (%)
Medicamente cardiovasculare
Antiaritmice
Amiodarona
<5
LEGARE
A DE
PROTEIN
E (%)
T N /
AFECTAR
E
RENAL
(H)
14-120 zile/
neschimbat
Digoxin
76-85
20-30
36-44/ 80120
Dobutamina
<10
?
2 min/ ?
Lidocaina
10
60-66
2,2/ 3,0
Mexiletin
10
70-75
8/ 13-16
Propafenona
<1
>95
12/?
Sotalol
60
<1
?
Inhibitori ai enzimei de conversie a angiotensinei (IECA)
Benazepril
20
95
22/30
Captopril
30-40
25-30
1,9/ 21-32
Enalapril
43
96
50-60
Fosinopril
<1
95
Lisinopril
80-90
0-10
Quinapril
30
97
Ramipril
10-21
55-70
Blocani ai receptorilor de angiotensin
24/ 34-60
11-12/12-20
12,6/ 40-50
1-2/ 6-15
5,8/ 15,0
AJUSTAREA DOZEI/FRECVENEI
ADMINISTRRII FUNCIE DE
RFG (ML/MIN)
DOZA
SUPLIMENTAR
PENTRU
RFG > 50
RFG 10-50
RFG < 10
HD
DIALIZ
PERITON
EAL
100%
100%
100%
Fr
Fr
100% q24h
25-75%
q36h
100%
100%
100%
100%
30%
10-25%
q48h
100%
100%
50-75%
100%
15-30%
Fr
Fr
?
Fr
Fr
Fr
80 mg
?
Fr
Fr
Fr
Fr
75-100%
75% q1218h
75-100%
50%
50% q24h
25-30%
25-30%
Fr
Fr
50%
20-25%
Fr
100%
50-75%
75-100%
50-75%
75%
25-50%
50%
25-50%
Fr
20%
25%
20%
Fr
Fr
Fr
Fr
100%
100%
100%
100%
100%
100%
100% q812h
100% q812h
100%
100%
100%
100%
MEDICAMEN
TUL
EXCREIE
NEALTER
AT (%)
LEGARE
A DE
PROTEIN
E (%)
T N /
AFECTAR
E
RENAL
(H)
AJUSTAREA DOZEI/FRECVENEI
ADMINISTRRII FUNCIE DE
RFG (ML/MIN)
DOZA
SUPLIMENTAR
PENTRU
RFG > 50
RFG 10-50
RFG < 10
HD
DIALIZ
PERITON
EAL
?
100%
Fr
Fr
25-50%
Fr
Fr
Fr
Candesartan
33
99
9/?
100%
Irbesartan
20
90
12-20/?
100%
Losartan
Beta-blocani
Atenolol
10
30
3/4
100%
Initial 2 mg,
titrat fc de
TA (16 mg)
Start 75 mg,
titrat fc de
TA
100%
>90
6,7/ 15-35
100% q24h
50% q48h
Carvedilol
<2
95
100%
100%
5-8/
neschimbat
3,5/ 2,5-4,5
30-50%
q96h
100%
100%
100%
100%
50 mg
Fr
>95
98
98-99
97
83-93
30-50/ 50
2-8/ 3,5
5/ 5-7
5,5/ 5-7
3-7/ 2,4-4,0
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Fr
Fr
Fr
Fr
Fr
Fr
Fr
Fr
Fr
Fr
20-40
<15
6-23/ 38-42
1,5-6,0/ 6-
100%
q8h
100%
q8-12h
100%
Q12-24h
Fr
250 mg
Fr
Fr
Metoprolol
5
Blocani ai canalelor de calciu
Amlodipina
<10
Diltiazem
<10
Nicardipina
<1
Nifedipina
<10
Verapamil
<10
Ageni cu aciune central
Clonidina
45
Metildopa
25-40
MEDICAMEN
TUL
EXCREIE
NEALTER
AT (%)
LEGARE
A DE
PROTEIN
E (%)
T N /
AFECTAR
E
RENAL
(H)
16
Medicamente antiulceroase / inhibitori de pomp de protoni
Omeprazol
<1
95
0,5-1,0/
neschimbat
Famotidina
65-80
15-22
2,5-4,0/1219
Ranitidina
80
15
1,5-3,0/6-9
Antidiabetice
Clorpropamida
47
91-99
24-48/ 50200
Glipizid
4,5-7,0
97
3-7/?
Gliburid
50
99
1,4-2,9/?
Metformin
90-100
Neglijabil
1-5/
prelungit
Rosiglitazona
Hepatic
99
3-4/
neschimbat
Hipolipemiante
Atorvastatin
<2
>98
14/?
Gemfibrozil
Fr
97-99
7,6/
neschimbat
Simvastatin
<0,5
>95
?
AJUSTAREA DOZEI/FRECVENEI
ADMINISTRRII FUNCIE DE
RFG (ML/MIN)
DOZA
SUPLIMENTAR
PENTRU
RFG > 50
RFG 10-50
RFG < 10
HD
DIALIZ
PERITON
EAL
100%
100%
100%
50%
25%
10%
Fr
Fr
75%
50%
25%
50%
Fr
50%
A se evita
A se evita
100%
?
50%
100%
A se evita
25%
100%
A se evita
A se evita
?
Fr
?
?
Fr
?
100%
100%
100%
100%
?
100%
?
100%
?
100%
?
Fr
?
?
100%
100%
100%
CLEARANC
>80
60-80
E
CREATININ
Doza de
Doza q24h (mg/kg)
antibiotic
Amikacin/
15,0
12,0
Kanamicin
Gentamicin/
5,1
4,0
Tobramicin
40-60
30-40
20-30
10-20
<10
Doza q48h/mg/kg)
7,5
4,0
7,5
4,0
3,0
3,5
2,5
4,0
3,0
2,0