Drug elimination
Drug elimination is usually via the kidney:
- glomerular filtration - e.g. creatinine, digoxin, gentamicin
- tubular secretion - penicillin
- passive reabsorption - aspirin, quinidine, amphetamine
Renal failure is important if a drug:
- is more than 50% excreted unchanged
- has active metabolites excreted unchanged
- has a low toxic/therapeutic ratio, e.g. digoxin, gentamicin and other aminoglycosides, procainamide, lithium, methotrexate.
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