Dosage Adjustment of Antiretroviral Agents in Patients With Organ Dysfunction

Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

Dosage Adjustment of Antiretroviral Agents in Patients With Organ Dysfunction

American Journal of Health-System Pharmacy (12/01/98) Vol. 55, No. 23, P. 2528
Hilts, Alexandra E.; Fish, Douglas N.

Alexandra D. Hilts and Douglas N. Fish, of the Denver University Hospital and the University of Colorado Health Sciences Center, respectively, provide an overview of dosage adjustment recommendations based on current research for people with impaired renal or hepatic function taking HIV medications. They note, though, that many of the current medications are very recent and were quickly approved so there may be a lack of information on the subject in some cases. Halving of the zidovudine dosage is recommended due to toxicity issues among patients who have severe renal or hepatic impairment or receive hemodialysis. Similar reductions are suggested for patients on didanosine or zalcitabine, although there are no formal recommendations for dose reduction among patients with hepatic dysfunction. Dosage adjustments should be made based on mean creatinine clearance for patients with renal problems receiving stavudine or patients receiving hemodialysis on stavudine or lamivudine. Patients on stavudine with liver disease should be monitored for toxicity, while pharmokinetic alterations are likely to be minimal for similar patients receiving lamivudine. Patients on non-nucleoside reverse-transcriptase inhibitors with renal dysfunction do not need dosage adjustment, although patients with hepatic impairment may require a change in dosage. Renal dysfunction or hemodialysis does not require that patients receiving the protease inhibitors saquinavir, ritonavir, indinavir or nelfinavir change their dosage levels. Patients with hepatic impairment should decrease their indinavir dosage. Patients with hepatic dysfunction taking other protease inhibitors may experience drug accumulation, but no recommendations for treatment alteration have been made.

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