Antiretroviral Dosing in Organ Dysfunction

                     Renal Dysfunction/ Creatinine Clearance                               Hepatic Dysfunction
 

>50

26-28

10-25

<10

Hemodialysis
  Hepatic Dysfunction
Zidovudine 200 mg q8h 200mg q8h 100mf q8h 100mg q8h 100mg q8h 100mg q8h
Didanosine
     >60kg
     <60kg
200mg q 12h
125mg q 12h
200mg q 24h
125mg q 24h
100mg q 24h
 50mg q 24h

 

100mg q 24h
 50mg q 24h


100mg q 24h
 50mg q 24h		 Consider empiric dose reduction in moderate to severe disease
Zalcitabine 0.75mg q 8h 0.75mg q 12h 0.75mg q 12h 0.75mg q 24h 0.75mg q 24h 0.75mg q 8h
Stavudine
      >60kg
      <60kg
40mg q 12h
30mg q 12h

 

40mg q 24h
30mg q 24h


20mg q 24h
15mg q 24h

 

20mg q 24h
15mg q 24h

 

20mg q 24h
15mg q 24h

 

40mg q 12h
30mg q 12h

Lamivudine 150 mg q12h  150 mg q24h 
150mg x 1, then 100mg q 24h 
150mg x 1, then 25-50mg q 24h 
150mg x 1, then 25-50mg q 24h 		 150 mg q12h 
Nevirapine 200mg q12h  200mg q12h  200mg q12h  200mg q12h  NR CEDR
Delavirdine 400mg q8h  400mg q8h  400mg q8h  400mg q8h  NR CEDR
Efavirenz 600mg q24h  600mg q24h  600mg q24h  600mg q24h  NR CEDR
Saquinavir 600mg q8h  600mg q8h  600mg q8h  600mg q8h  NR CEDR
Ritonavir 600mg q12h  600mg q12h  600mg q12h  600mg q12h  NR CEDR
Indinavir 800mg q8h  800mg q8h  800mg q8h  800mg q8h  NR Mild to mod:600mg q8h; severe-further reduction  

NR= No recommendations
CEDR = Consider empiric dose reduction
Source: Hilts AE, Fish DN: Am J Health Syst Pharm 55, 1998