In renal impairment
As for any prescribing in renal impairment, appendix III in the BNF should be consulted.
Renal impairment is common, increasing in the elderly. Toxicity occurs frequently and is avoidable. Mechanisms include:
- diminished renal excretion
- plasma protein binding
- altered drug action, e.g. CNS depressants, hypotensive vasodilators, anticoagulants, NSAIDS, acetylcholinesterase inhibitors
Reference
- Jackson EK. Drugs affecting renal excretory function. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 445-70.
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