Dose adjustment in renal impairment: Response from Drug Prescribing in Renal Failure

doi:10.1136/bmj.331.7511.293-a

BMJ 2005;331:293-294 (30 July), doi:10.1136/bmj.331.7511.293-a

Letter

Dose adjustment in renal impairment

Response from Drug Prescribing in Renal Failure

The first 150 words of the full text of this article appear below.

EDITOR—Vidal et al should be congratulated on the firstscholarly, systematic review of secondary sources of prescribinginformation for patients with impaired renal function (p 263).¹That they found inconsistent and conflicting recommendationsacross multiple sources is not surprising. Their work underscoresseveral problems with which we have struggled to compile ourdosing recommendations in Drug Prescribing in Renal Failure.²

Early regulatory requirements did not include formal efficacy,safety, or pharmacokinetic studies for drugs in special populations,including patients with impaired kidney or liver function. Consequently,dosing recommendations for many older drugs are based on flimsydata, including sparse case reports, common usage, and pharmacokineticextrapolations from studies in subjects with normal renal function.in patients with impaired renal function, but the reports areoften absent from the critically reviewed, scientific literature.The results are buried in regulatory reports or found only inother secondary . . . [Full text of this article]

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George R Aronoff, professor of medicine and pharmacology

University of Louisville Kidney Disease Program, 615 South Preston Street, Louisville, KY 40202, USA George.Aronoff@kdp.louisville.edu

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Systematic comparison of four sources of drug information regarding adjustment of dose for renal function: Liat Vidal, Maya Shavit, Abigail Fraser, Mical Paul, and Leonard Leibovici
BMJ 2005 331: 263. [Abstract] [Full Text] [PDF]