Medication Safety
Many people with chronic kidney disease also have other chronic conditions and take multiple medications. Some drugs used to treat other conditions are cleared through the kidneys. This increases the risk of harm, including acute kidney injury.
The following medications commonly prescribed in primary care should be avoided or dose-adjusted for people with chronic kidney disease. The list was developed through a modified Delphi panel of 17 experts in nephrology, primary care and pharmacology.i
Medications that Must be Considered for Dose Adjustment or Avoidance
Generic Name | Brand Name | eGFR <15 | eGFR 15-29 | eGFR 30-44 | eGFR 45-59 |
---|---|---|---|---|---|
Gabapentin | Neurontin | Adjust dose | Adjust dose | Adjust dose | No Action |
Pregabalin | Lyrica | Adjust dose | Adjust dose | Adjust dose | Adjust dose |
Note: eGFR ranges (ml/min/1.73 m2)
Generic Name | Brand Name | eGFR <15 | eGFR 15-29 | eGFR 30-44 | eGFR 45-59 |
---|---|---|---|---|---|
Ciprofloxacin (Oral) | Cipro | Adjust dose | Adjust dose | No Action | No Action |
Trimethoprim-Sulfamethoxazole | Septra, Bactrim, Co- Trimoxazole | Adjust dose | Adjust dose | No Action | No Action |
Levofloxacin (Oral) | Levaquin | Adjust dose | Adjust dose | No Action | No Action |
Nitrofurantoin | Macrobid ; Macrodantin | Avoid | Avoid | No Action | No Action |
Note: eGFR ranges (ml/min/1.73 m2)
Generic Name | Brand Name | eGFR <15 | eGFR 15-29 | eGFR 30-44 | eGFR 45-59 |
---|---|---|---|---|---|
Acyclovir (Oral) | Zovirax | Adjust dose | Adjust dose | No Action | No Action |
Famciclovir | Famvir | Adjust dose | Adjust dose | Adjust dose | No Action |
Oseltamivir | Tamiflu | Adjust dose | Adjust dose | Adjust dose | No Action |
Valacyclovir | Valtrex | Adjust dose | Adjust dose | Adjust dose | No Action |
Note: eGFR ranges (ml/min/1.73 m2)
Generic Name | Brand Name | eGFR <15 | eGFR 15-29 | eGFR 30-44 | eGFR 45-59 |
---|---|---|---|---|---|
Apixaban | Eliquis | Avoid | Adjust dose | No Action | No Action |
Dabigatran | Pradaxa | Avoid | Avoid | No Action | No Action |
Edoxaban | Lixiana | Avoid | Adjust dose | Adjust dose | No Action |
Rivaroxaban | Xarelto | Avoid | Adjust dose | Adjust dose | No Action |
Note: eGFR ranges (ml/min/1.73 m2)
Generic Name | Brand Name | eGFR <15 | eGFR 15-29 | eGFR 30-44 | eGFR 45-59 |
---|---|---|---|---|---|
Canagliflozin | Invokana | Avoid | Avoid | Adjust dose | No Action |
Dapagliflozin | Forxiga | Avoid | Avoid | Avoid | No Action |
Empagliflozin | Jardiance | Avoid | Avoid | Adjust dose | No Action |
Gliclazide | Diamicron; Diamicron MR |
Adjust dose | No Action | No Action | No Action |
Glyburide | Diabeta | Avoid | Avoid | Adjust dose | No Action |
Metformin | Glucophage; Glycon Extended release: Glumetza |
Avoid | Avoid | Adjust dose | No Action |
Saxagliptin | Onglyza | Avoid | Adjust dose | Adjust dose | No Action |
Sitagliptin | Januvia | Adjust dose | Adjust dose | Adjust dose | No Action |
Note: eGFR ranges (ml/min/1.73 m2)
Generic Name | Brand Name | eGFR <15 | eGFR 15-29 | eGFR 30-44 | eGFR 45-59 |
---|---|---|---|---|---|
Solifenacin | Vesicare | Adjust dose | Adjust dose | No Action | No Action |
Tolterodine | Detrol; Detrol LA | Adjust dose | Adjust dose | No Action | No Action |
Note: eGFR ranges (ml/min/1.73 m2)
Generic Name | Brand Name | eGFR <15 | eGFR 15-29 | eGFR 30-44 | eGFR 45-59 |
---|---|---|---|---|---|
Duloxetine | Cymbalta | Avoid | Adjust dose | No Action | No Action |
Escitalopram | Cipralex | Adjust Dose | No Action | No Action | No Action |
Venlafaxine | Effexor XR | Adjust dose | Adjust dose | Adjust dose | No Action |
Note: eGFR ranges (ml/min/1.73 m2)
Generic Name | Brand Name | eGFR <15 | eGFR 15-29 | eGFR 30-44 | eGFR 45-59 |
---|---|---|---|---|---|
Alendronate | Fosamax | Avoid | Adjust dose | No Action | No Action |
Risedronate | Actonel | Avoid | Adjust dose | No Action | No Action |
Etidronate | Didronel | Avoid | Adjust dose | No Action | No Action |
Zoledronic Acid | Aclasta | Avoid | Adjust dose | No Action | No Action |
Note: eGFR ranges (ml/min/1.73 m2)
Generic Name | Brand Name | eGFR <15 | eGFR 15-29 | eGFR 30-44 | eGFR 45-59 |
---|---|---|---|---|---|
Bezafibrate | Bezalip | Avoid | Adjust dose | No Action | No Action |
Fenofibrate | Lipidil | Avoid | Adjust dose | No Action | No Action |
Gemfibrozil | Lopid | Avoid | Adjust dose | No Action | No Action |
Note: eGFR ranges (ml/min/1.73 m2)
Generic Name | Brand Name | eGFR <15 | eGFR 15-29 | eGFR 30-44 | eGFR 45-59 |
---|---|---|---|---|---|
Baclofen (Oral) | Lioresal | Avoid | Adjust dose | Adjust dose | No Action |
Colchicine | COLCHICINE | Adjust dose | Adjust dose | No Action | No Action |
Digoxin (Oral) | Toloxin, Lanoxin | Adjust dose | Adjust dose | Adjust dose | No Action |
Lithium | Carbolith; Sustained-release: Lithmax | Adjust dose | Adjust dose | Adjust dose | No Action |
Metoclopramide | Maxeran | Adjust dose | Adjust dose | Adjust dose | No Action |
Rosuvastatin | Crestor | Adjust dose | No Action | No Action | No Action |
Spironolactone | Aldactone | Adjust dose | Adjust dose | No Action | No Action |
Note: eGFR ranges (ml/min/1.73 m2)
Disclaimer: The information contained herein (“Information”) is intended for informational purposes only, and no warranty as to its accuracy is provided or implied. The Information was collected from third party sources and is subject to change without notice. Cancer Care Ontario (CCO) makes no warranty that the Information is current. The Information is intended for use by healthcare professionals, subject to their clinical and/or professional judgment. Do not act or rely upon the Information without exercising your independent judgment or seeking the advice of a qualified professional. Anyone using the Information does so at his or her own risk. CCO does not endorse the use of any drug or treatment method described herein.
i Taji, L., Battistella, M., Grill, A.K., Cunningham, J., Quinn, K., Thomas, A., Brimble, K.S. (2018) Medications to be dose-adjusted or avoided in people with chronic kidney disease: Results of a modified Delphi study. Manuscript submitted for publication