Prescribing in Renal Impairment

Key points

• Renal impairment → accumulation of renally-cleared drugs and their metabolites.
• Drugs requiring dose reduction/monitoring: digoxin, LMWH, aminoglycosides, metformin, allopurinol, lithium.
• Nephrotoxic drugs to avoid or use with caution: NSAIDs, ACE inhibitors (monitor K⁺/creatinine), aminoglycosides, contrast media.
• Water-soluble drugs have smaller volume of distribution — more affected by renal failure.

Decision points in this pathway

• Nephrotoxic drug needed?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.