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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. For more information, please email the KidneyWise team.

Medications that Must be Considered for Dose Adjustment or Avoidance

Anti-convulsants
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)

Antibiotic
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)

Antiviral
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)

Direct oral anti-coagulants
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)

Oral hypoglycemic
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)

Anti- muscarinics or Medications for Overactive Bladder
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)

Anti-depressants
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)

Bisphosphonates
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)

Fibrates
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)

Other drugs
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