Supported By

Drugs
2011 Dialysis of

2011

Dialysis of Drugs

George R. Bailie, PharmD, PhD Albany College of Pharmacy and Health Sciences Nancy A. Mason, PharmD University of Michigan College of Pharmacy Renal Pharmacy Consultants, LLC Saline, Michigan USA

2011 Dialysis of Drugs

DISCLAIMERThese Dialysis of Drugs guidelines are offered as a general summary of information for pharmacists and other medical professionals. Inappropriate administration of drugs may involve serious medical risks to the patient that can only be identied by medical professionals. Depending on the circumstances, the risks can be serious and can include severe injury, including death. These guidelines cannot identify medical risks specic to an individual patient or recommend patient treatment. These guidelines are not to be used as a substitute for professional training. The absence of typographical errors is not guaranteed. Use of these guidelines indicates acknowledgment that neither Renal Pharmacy Consultants, LLC., nor Genzyme will be responsible for any loss or injury, including death, sustained in connection with or as a result of the use of these guidelines. Readers should consult the approved Product Information for each agent indicated before prescribing medications. Guides such as this one can only draw from information available as of the date of publication. Neither Renal Pharmacy Consultants, LLC. nor Genzyme is under any obligation to update information contained herein. Future medical advances or product information may affect or change the information provided. Pharmacists and other medical professionals using these guidelines are responsible for monitoring ongoing medical advances relating to dialysis. Copyright 2011, Renal Pharmacy Consultants, LLC. All rights reserved. This material may not be published, rewritten or redistributed.
2 SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I FOREWORD

Foreword
Dialysis of Drugs has been a popular clinical tool for nearly two decades. This resource is used around the world by nurses, pharmacists, physicians and other professionals caring for dialysis patients. Since writing the rst edition, my goal has been to provide the busy clinician the best available answer to the common question of whether a medication is removed from the blood by dialysis and whether a replacement dose may be required following dialysis. This information enhances the safe and effective use of medications in a complex and therapeutically challenging patient. With great pleasure, I now transfer responsibility for the future publication of Dialysis of Drugs to two long-time colleagues, George Bailie and Nancy Mason. Dr. Bailie and Dr. Mason are very experienced nephrology pharmacists who will continue to meet the informational needs of dialysis professionals regarding drug dialyzability. Knowing their skill and knowledge of pharmacotherapy in dialysis patients, I am condent that Dialysis of Drugs will continue to be a valuable resource in the future. Curtis A. Johnson, PharmD December 2010

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Preface
Drug removal during dialysis is frequently of interest to those caring for patients receiving hemodialysis or peritoneal dialysis. The extent of drug dialyzability determines whether supplemental dosing is necessary during or following dialysis. The accompanying table is a reference regarding the effect of either form of dialysis on drug clearance. This table should be used as a general guideline. The drugs included in the table are parent drugs. In some cases, these drugs are converted to pharmacologically active or toxic metabolites for which little dialysis information is known. Therefore, for a few drugs, a primary metabolite is also included in the table. When available, serum drug measurements may be appropriate for dosing individual patients. In all cases, patients should be monitored for clinical efcacy and toxicity.

What Determines Drug Dialyzability?

The extent to which a drug is affected by dialysis is determined primarily by several physicochemical characteristics of the drug that are briey described in the text that follows. These include molecular size, protein binding, volume of distribution, water solubility, and plasma clearance. In addition to these properties of the drug, technical aspects of the dialysis procedure also may determine the extent to which a drug is removed by dialysis.
4 SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I PREFACE

Molecular Weight
Dialysis is dependent upon the use of a dialytic membrane: either a synthetic membrane with xed pore size, as in hemodialysis, or a naturally occurring peritoneal membrane, as in peritoneal dialysis. The movement of drugs or other solutes is largely determined by the size of these molecules in relation to the pore size of the membrane. As a general rule, smaller molecular weight substances will pass through the membrane more easily than larger molecular weight substances. A common assumption is that pore size of the peritoneal membrane is somewhat larger than that of the hemodialysis membrane. This would explain the observation that larger molecular weight substances appear to cross the peritoneal membrane to a greater extent than the hemodialysis membrane.

Protein Binding
Another important factor determining drug dialyzability is the concentration gradient of unbound (free) drug across the dialysis membrane. Drugs with a high degree of protein binding will have a low plasma concentration of unbound drug available for dialysis. Uremia may have an effect on protein binding for some drugs. Through mechanisms not completely understood, protein binding may decrease in uremic serum. Should this change in binding be substantial, increased dialyzability of free drug may occur.

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Because the primary binding proteins for most drugs (albumin, 1-acid glycoprotein) are of large molecular size, the drug-protein complex is often unable to cross the dialysis membrane, especially the hemodialysis membrane. Since the peritoneal membrane does permit the passage of some proteins, there may be some limited drug-protein removal with peritoneal dialysis. Increased protein concentrations often occur in peritoneal efuent during episodes of peritonitis.

Volume of Distribution
A drug with a large volume of distribution is distributed widely throughout tissues and is present in relatively small amounts in the blood. Factors that contribute to a large volume of distribution include a high degree of lipid solubility and low plasma protein binding. Drugs with a large volume of distribution are likely to be dialyzed minimally.

Water Solubility
The dialysate used for either hemodialysis or peritoneal dialysis is an aqueous solution. In general, drugs with high water solubility will be dialyzed to a greater extent than those with high lipid solubility. Highly lipid-soluble drugs tend to be distributed throughout tissues, and therefore only a small fraction of the drug is present in plasma and accessible for dialysis.

Plasma Clearance
The inherent metabolic clearancethe sum of renal and nonrenal clearanceis often termed
6 SEE DISCLAIMER REGARDING USE OF THIS GUIDE

the plasma clearance of a drug. In dialysis patients, renal clearance is largely replaced by dialysis clearance. If nonrenal clearance is large compared to renal clearance, the contribution of dialysis to total drug removal is low. However, if renal (dialysis) clearance increases plasma clearance by 30% or more, dialysis clearance is considered to be clinically important.

I PREFACE

Dialysis Membrane
As mentioned previously, the characteristics of the dialysis membrane determine to a large extent the dialysis of drugs. Pore size, surface area, and geometry are the primary determinants of the performance of a given membrane. The technology of hemodialysis has evolved, and new membranes have been introduced for clinical use. Interpretation of published literature should be tempered with the understanding that newer hemodialysis membranes may have different drug dialysis characteristics. Little can be done to alter the characteristics of the peritoneal membrane.

Blood and Dialysate Flow Rates

The hemodialysis prescription includes the desired blood and dialysate ow rates. As drugs normally move from blood to dialysate, the ow rates of these two substances may have a pronounced effect on dialyzability. In general, increased blood ow rates during hemodialysis will deliver greater amounts of drug to the dialysis membrane. As the drug concentration increases in the dialysate, the ow rate of the dialysis solution also becomes important in
SEE DISCLAIMER REGARDING USE OF THIS GUIDE 7

2011 Dialysis of Drugs

overall drug removal. Greater dialysis can be achieved with faster dialysate ow rates that keep the dialysate drug concentration at a minimum. During peritoneal dialysis, little can be done to alter blood ow rates to the peritoneum. However, dialysate ow rates are determined by the volume and frequency of dialysate exchange in the peritoneum. At low exchange rates, drug concentrations in the dialysate will increase during the time in which the dialysate resides in the peritoneum, thus slowing additional movement of drug across the membrane. More frequent exchanges will favor increased drug dialyzability, provided the drugs physicochemical characteristics permit its movement across the peritoneal membrane.

Special Considerations
HIGH PERMEABILITY DIALYSIS Much of the information contained in this guide has been obtained from studies conducted under conditions of standard hemodialysis that employed conventional dialysis membranes. Changes in dialysis technology have led to more permeable dialysis membranes and the opportunity to employ higher blood and dialysate ow rates. These technologies are often referred to as high permeability, highefciency, and high-ux dialysis. The United States Food and Drug Administration has classied high permeability dialysis membranes as those whose in vitro ultraltration coefcient (KUf) is greater than 8 mL/hour/mm Hg.
8 SEE DISCLAIMER REGARDING USE OF THIS GUIDE

Commonly included in this group of dialysis membranes are polysulfone, polyacrylonitrile, and high-efciency cuprammonium rayon dialyzers. Changes in dialysis membranes and changes in blood and dialysis ow rates may have clinically important effects on drug removal through the membrane. There is an increasing number of studies that examine the effects of high permeability dialysis on drug dialyzability. Results of these studies conrm predictions that drug removal from plasma is often enhanced as compared with more traditional dialysis membranes. Studies with high permeability dialysis also demonstrate that removal of drug from plasma often exceeds the transfer of drug from tissues to plasma. As a result, a rebound of plasma drug concentrations following the conclusion of dialysis may occur as blood-tissue drug equilibration occurs. Patients receiving high permeability dialysis may require more drug compared with those receiving standard hemodialysis. Due to the many technical and physiological variables, individualized therapeutic drug monitoring may be necessary. The reader is referred to the primary literature for further details. CONTINUOUS RENAL REPLACEMENT THERAPY Another therapeutic development that will affect drug dialyzability is continuous renal replacement therapy (CRRT), known in its various forms as continuous arteriovenous hemoltration (CAVH), continuous venovenous hemoltration (CVVH), continuous
SEE DISCLAIMER REGARDING USE OF THIS GUIDE 9

I SPECIAL CONSIDERATIONS

2011 Dialysis of Drugs

arteriovenous hemodialysis (CAVHD), continuous venovenous hemodialysis (CVVHD), continuous venovenous hemodialtration (CVVHDF), continuous arteriovenous hemodialtration (CAVHDF), slow continuous ultraltration (SCUF), continuous arteriovenous high-ux hemodialysis (CAVHFD), and continuous venovenous high-ux hemodialysis (CVVHFD). These various techniques are used in the management of acute renal failure in critically ill patients. Continuous renal replacement therapies differ considerably from intermittent hemodialysis. Relying heavily upon continuous ultraltration of plasma water, CRRT has the potential for the removal of large quantities of ultralterable drugs contained in plasma. Unfortunately, few in vivo studies have been published, and very few drugs have been studied pharmacokinetically in intensive care patients. Therefore, many guidelines for drug dosing during CRRT are extrapolated from experiences with chronic hemodialysis or from theoretical considerations based upon general principles of drug removal derived from the physicochemical characteristics of the drug and the CRRT technique employed. Molecular weight of a drug has been an important determinant of drug dialyzability in conventional hemodialysis. This drug characteristic becomes less important during CRRT because of the use of highux hemolters that permit passage of larger molecules up to 5000 Da. As is true with conventional hemodialysis, drugs with a
10 SEE DISCLAIMER REGARDING USE OF THIS GUIDE

large volume of distribution are unlikely to be removed to a great extent during CRRT. Most of the body stores of such drugs are outside the vascular compartment and not accessible to the hemolter for removal. Similarly, drugs that are highly bound to plasma proteins are not subject to signicant removal during CRRT because the molecular weight of drug-protein complexes usually hinders passage of the complex across the lter. The fraction of unbound drug may change during renal failure, however, thus altering the likelihood of drug removal. If the unbound fraction increases, more drug clearance may occur. If the unbound fraction becomes less, there is likely to be less drug removal during CRRT. A useful tool to predict the likelihood of a drug to cross the hemolter membrane is the sieving coefcient. This term is dened as the ratio of drug concentration in the ultraltrate to the prelter plasma water concentration of the drug. If the sieving coefcient is close to 1.0, the drug has relatively free passage across the lter. The following table presents sieving coefcient data from in vitro and in vivo evaluations. SIEVING COEFFICIENT
Drug Name Amikacin Amphotericin Ampicillin Cefotaxime Cefoxitin Predicted Measured Condition Filter 0.95 0.88 in vivo PSa 0.10 0.40 in vivo PSa 0.80 0.69 in vivo PSa 0.62 0.51 in vivo PSa 0.30 0.30 in vitro PSa

I SPECIAL CONSIDERATIONS

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

11

2011 Dialysis of Drugs

Drug Name Ceftazidime Ceftriaxone Cefuroxime Clindamycin Digoxin

Predicted Measured Condition Filter 0.90 0.90 in vivo PSa 0.10 0.71 in vivo PSa 0.66 0.59 in vivo PSa 0.40 0.80 0.98 0.96 0.35 0.18 1.21 1.07 in vivo in vivo in vitro in vitro in vitro in vitro in vivo in vivo in vivo in vivo in vivo in vivo in vivo in vivo in vivo in vitro in vitro in vitro in vitro in vitro in vivo in vitro in vitro in vivo PSa PSa PSa PSb AN69c PAd PSa PSa PSa PSa PSa PSa PSa PSa PSa PSa PSb AN69c PAd PSa PSa PSa AN69c PAd

Erythromycin Gentamicin Metronidazole Mezlocillin N-acetylprocainamide Nafcillin Oxacillin Phenobarbital Phenytoin

0.30 0.95 0.80 0.68 0.90 0.20 0.05 0.60 0.10

0.37 0.81 0.86 0.68 0.92 0.54 0.02 0.86 0.45 0.14 0.12 0.08 0.17 0.08

Procainamide Theophylline

0.86 0.47

0.86 0.85 0.93 0.78

12

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I SPECIAL CONSIDERATIONS

Drug Name Tobramycin Tobramycin

Predicted Measured Condition Filter 0.95 0.95 0.78 0.90 0.75 0.59 0.76 0.18 0.31 0.16 0.76 0.60 0.71 0.64 0.58 in vivo in vitro in vitro in vitro in vitro in vitro in vitro in vitro in vivo in vitro in vitro in vitro in vitro PSa PSa PSb AN69c PAd PSa AN69c PAd PSa PSa PSb AN69c PAd

Valproic acid

0.10

Vancomycin

0.90

Amicon dialter (polysulfone) Renal System (polysulfone) c Hospal (AN69) d Gambro (polyamide) The above table was published in the following article: Joy MS, Matzke, GR, Armstrong DK, Marx MA, Zarowitz BJ. A primer on continuous renal replacement therapy for critically ill patients. Ann Pharmacother. 1998;32:362-75. Reprinted with permission. Harvey Whitney Books Company.
b

The specic CRRT technique employed will inuence the ultraltration rate and hence, the potential rate of drug removal. When CRRT relies solely on spontaneous blood ow without extracorporeal blood pumping, an ultraltration rate of 10-15 mL/min is anticipated. The addition of blood pumps and continuous dialysis may increase the ultraltration rate
SEE DISCLAIMER REGARDING USE OF THIS GUIDE 13

2011 Dialysis of Drugs

to 50 mL/min. Higher rates of ultraltration may lead to greater drug removal with a need for more frequent replacement doses. Drug removal can be determined by collection of the total volume of dialysate/ultraltrate and measurement of the concentration of drug in the efuent. Because of the multiple techniques employed in CRRT, the variability in individual patient circumstances, and the lack of in vivo data, the tables in this guide do not contain information on drug removal during CRRT. Once again, the reader is referred to the primary literature for assistance with the dosing of specic drugs. PLASMAPHERESIS Plasmapheresis is another special consideration in which drug removal from plasma may be of concern. This technique is used for the treatment of certain immunologic, infectious, and metabolic diseases, as well as for the removal of toxins that cannot be removed by hemodialysis or peritoneal dialysis. Plasmapheresis removes plasma from the patient with replacement by crystalloid or colloid solutions. Solutes such as drug molecules that are present in the plasma may be removed from the patient. Unfortunately, little is known about the specic pharmacokinetic effects of plasmapheresis. The procedure may be most likely to remove substances that are lipophilic, that are highly protein-bound, and that have a small volume of distribution. The reader is referred to reference 5.

14

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

SUMMARY Drug dialyzability is determined by a complex interaction of many factors, including the characteristics of the drug and the technical aspects of the dialysis system. Published studies on drug dialyzability should specify the conditions that pertain during dialysis. Results from these studies should be applied with caution to other dialysis conditions.

I ABOUT THIS GUIDE

About This Guide

These guidelines are designed to provide extensive, easy-to-read information regarding the dialyzability of drugs. Numerous literature sources have been used in preparing the guidelines. For many drugs, including newlyapproved medications, investigational agents and medications available in other countries, no studies have been done to determine the effect of dialysis on drug removal. In some cases, the available data may conict. Conditions of dialysis used in published studies may not necessarily reect current dialysis procedures and technology. Variations in the duration of dialysis, ow rates, dialysis membranes, and whether peritoneal dialysis is continuous or intermittent will all affect drug removal. This educational review will distinguish between conventional hemodialysis and high permeability (often called highux) hemodialysis where such data are available. However, the review does not contain information on drug dialyzability with CRRT (See Special Considerations) or with plasmapheresis. For additional information on
SEE DISCLAIMER REGARDING USE OF THIS GUIDE 15

2011 Dialysis of Drugs

specic drugs, the reader should consult the primary literature. A designation of Yes in the Hemodialysis and Peritoneal Dialysis columns indicates that dialysis enhances plasma clearance by 30% or more. Supplemental dosing may be required or dosing after dialysis should be considered. No indicates that dialysis does not have a clinically important effect on plasma clearance. Supplemental dosing is usually not required. As a general principle, usual methods of continuous ambulatory peritoneal dialysis (CAPD) provide relatively low drug clearances during any given dialysate exchange. However, cumulative drug removal may require dosage supplementation at appropriate intervals. Relatively little research has examined peritoneal drug clearance in PD techniques that utilize automated systems employing large volumes of short dwells at night, often accompanied by one or more longer daytime dwells (APD). Similarly, little data exists on the effects of tidal peritoneal dialysis on drug clearance. A few studies have conrmed that clearance of some drugs is increased by APD due to the increased drug concentration gradient between blood and dialysate. Increased drug dialyzability may occur with increased peritoneal dialysate ow rates or in the presence of peritonitis. A designation of U indicates that no dialysis studies have been published, or that there is very limited information (such as case reports), but that the authors of this guide have concluded that signicant drug removal
16 SEE DISCLAIMER REGARDING USE OF THIS GUIDE

during dialysis is unlikely based upon the physicochemical characteristics of the drug, which are primarily a high degree of protein binding, a large molecular weight, or a large volume of distribution. A designation of L indicates that no published data exist on the removal of the drug during high permeability dialysis, or that there is very limited information (such as case reports). However, the authors have extrapolated data from studies using conventional dialysis to conclude that signicant drug removal is likely to occur during high permeability dialysis. A designation of ND indicates that no (or very limited) data are available on drug dialyzability. In some cases, the literature reports the use of a high permeability, or high-ux, dialysis membrane, however the type of membrane is not specied. A designation of NS indicates membrane type is not specied.

I ABOUT THIS GUIDE

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

17

2011 Dialysis of Drugs

Key
Yes Indicates that dialysis enhances plasma clearance by 30% or more. Supplemental dosing may be required or dosing after dialysis should be considered. No Indicates that dialysis does not have a clinically important effect on plasma clearance. Supplemental dosing is usually not required. U Indicates signicant drug removal is unlikely based on physicochemical characteristics of the drug such as protein binding, molecular size or volume of distribution L Indicates no published data exist, but information extrapolated from studies using conventional dialysis techniques suggests signicant drug removal is likely during high permeability dialysis ND Indicates there are no data on drug dialyzability with this type of dialysis NS Indicates the type of membrane was not specied * Removed with hemoperfusion Note: In these tables, conventional hemodialysis is dened as the use of a dialysis membrane whose in vitro coefcient of ultraltration (KUf) 8 mL/hour/mm Hg. Data also are placed in the conventional column if the literature does not specify the type of dialysis membrane employed. High permeability hemodialysis is dened as the use of a dialysis membrane whose KUf >8 mL/hour/mm Hg. In the tables, the KUf of the membrane(s) used is included in parentheses.

18

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Abacavir Abatacept Abciximab Acamprosate Acarbose Acebutolol (diacetolol) Acetaminophen Acetazolamide Acetohexamide Acetophenazine Acetylcysteine Acitretin Acrivastine Acyclovir Adalimumab Adefovir Adenosine Agalsidase alfa Agalsidase beta Albendazole Albumin Albuterol Alcaftadine Aldesleukin Alefacept Alemtuzumab Alendronate Alfentanil Alfuzosin Alglucerase

U U U ND ND Yes (NS) Yes (NS) U U U Yes (7.5) No (NS) ND Yes (NS) U Yes (NS) U No (7.5) U No (NS) U No (NS) ND) ND ND U No (NS) U U U

No (40) U ND ND ND L L ND ND ND ND U ND L U ND ND No (10) U ND ND ND ND ND ND U ND ND U U

ND U U ND ND ND No No U U ND U ND No U ND U U U U U U ND ND ND U ND U U U
19

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Aliskiren Alitretanoin Allopurinol Almotriptan Alosetron Alprazolam Alprostadil Alteplase Altretamine Alvimopan Amantadine Ambenonium Ambrisentan Amdinocillin Amifostine Amikacin Amiloride Aminocaproic acid Aminoglutethimide Aminosalicylic acid Amiodarone Amitriptyline Amlodipine Amoxapine Amoxicillin Amphetamine Amphotericin B Amphotericin B lipid complex Ampicillin
20

ND ND Yes (NS) ND ND No (NS) U U ND ND No (NS) ND U No (NS) ND Yes (NS) ND Yes (NS) Yes (NS) Yes (NS) No (NS) No (NS) No (NS) U Yes (NS) ND No (NS) No (NS) Yes (NS)

ND ND L ND ND ND No (11.1) ND ND ND ND ND U ND ND L ND ND L L U ND U U L ND No (10.1, 36) ND L

ND ND ND ND ND U ND U ND ND No ND U No ND Yes ND Yes ND ND No No No U No ND No U No

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Amprenavir U Amrinone U Amsacrine U Anagrelide ND Anakinra No (NS) Anastrozole ND Anidulafungin No (NS) Anisindione U Anisoylated plasminogen ND streptokinase activator complex Anistreplase U Antithymocyte globulin U (ATG) Apomorphine U Aprepitant No (NS) Aprotinin U Arbutamine ND Argatroban U Aripiprazole U Armodanil ND Arsenic trioxide No (NS) Artemether/ ND lumefantrine Articaine ND Ascorbic acid Yes (5.5) Asenapine U Asparaginase U Aspirin Yes (NS) Atazanavir U

ND ND U ND ND ND U U ND ND ND U U ND ND No (10.7-36) U ND ND ND ND Yes (8.8) U ND L U

U No U ND No ND U U ND U U U U U ND ND U ND U ND ND Yes U U Yes U
21

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Atenolol Atomoxetine Atorvastatin Atovaquone Atracurium Atropine Auranon Azacitidine Azathioprine Azelastine Azithromycin Azlocillin Aztreonam Baclofen Balsalazide Basiliximab Benazepril (benazeprilat) Bendamustine Bendroumethiazide Benzphetamine Benzquinamide Benztropine Bepridil Bepotastine besylate Beractant Besioxacin Betamethasone Betaxolol Bethanechol
22

Yes (NS) U No (NS) U U No (NS) No (NS) ND Yes (NS) U ND Yes (NS) Yes (NS) ND U U No (NS) U No (NS) ND U ND No (NS) ND U ND ND No (NS) ND

L U U ND ND ND ND ND L U ND L L Yes (60) U ND ND U ND ND ND ND ND ND U ND ND ND ND

No U U U U ND ND ND ND U No No No ND U U ND U U ND ND ND U ND U ND ND No ND

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Bevacizumab Bexarotene Bezabrate Biapenem Bicalutamide Biperiden Bisoprolol Bivalirudin Bleomycin Bortezomib Bosentan Bretylium Bromfenac Bromocriptine Brompheniramine Budesonide Buomedil Bumetanide Bupivacaine Buprenorphine Bupropion Buspirone Busulfan Butalbital Butoconazole Butorphanol Cabazitaxel Cabergoline Caffeine Calcitonin

U U No (NS) Yes (NS) U ND No (NS) Yes (NS) No (NS) ND U Yes (NS) No (NS) U ND U No (NS) U U U No (NS) No (NS) Yes (NS) ND U U U ND ND U

No (NS) U U Yes (NS) ND ND ND ND ND ND No (11.1) L U ND ND U No (20) U U U No (10) ND Yes (8.1) ND U ND U ND ND U

U U No ND U ND ND ND No ND U ND U U ND U U U U U No ND ND ND U U U ND ND U
23

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Calcitriol Calfactant Canakinumab Candesartan Capecitabine Capreomycin Captopril Carbamazepine Carbenicillin Carbidopa/levodopa Carbinoxamine Carboplatin Carboprost Carglumic acid Carisoprodol Carmustine Carprofen Carteolol Carumonam Carvedilol Caspofungin Cefaclor Cefadroxil Cefamandole Cefazolin Cefdinir Cefditoren Cefepime Cexime Cefmenoxime
24

No (4.2-5.3) ND U No (NS) ND Yes (NS) Yes (NS) No (NS) Yes (NS) ND/U ND Yes (NS) ND ND Yes (NS) No (NS) U ND Yes (NS) No (NS) No (NS) Yes (NS) Yes (NS) Yes (NS) Yes (6, 8) ND No (NS) Yes (NS) No (NS) Yes (NS)

No (31) ND U No (8.1) ND L L Yes (22, 55) L ND/U ND L ND ND L ND U ND L U U L L L Yes (8.1-60) Yes (NS) ND Yes (40, 60) ND L

U ND U ND ND ND No No No ND/U ND No ND ND Yes ND U ND ND U U Yes No No No ND ND Yes No ND

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Cefmetazole Cefodizime Cefonicid Cefoperazone Ceforanide Cefotaxime Cefoxitin Cefpirome Cefpodoxime Cefprozil Cefroxadine Cefsulodin Ceftazidime Ceftibuten Ceftizoxime Ceftobiprole Ceftriaxone Cefuroxime Celecoxib Cephalexin Cephalothin Cephapirin Cephradine Certolizumab Cetirizine Cetrorelix Cetuximab Cevimeline Chloral hydrate Chlorambucil

Yes (NS) No (NS) No (NS) No (NS) Yes (NS) Yes (NS) Yes (NS) Yes (NS) Yes (NS) Yes (NS) ND Yes (NS) Yes (NS) Yes (NS) Yes (NS) ND No (NS) Yes (NS) U Yes (NS) Yes (NS) Yes (NS) Yes (NS) U U ND No (NS) ND Yes (5.5) No (NS)

L ND ND ND L L L Yes (40) L L ND L L L L ND ND L U L L L L U No (18.7-66.7) ND U ND L ND

No No No No No No No No No ND ND Yes Yes ND No ND No No U No No No Yes U U ND U ND ND No

25

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Chloramphenicol Chlordiazepoxide Chloroquine Chlorothiazide Chlorpheniramine Chlorpromazine Chlorpropamide Chlorprothixene Chlorthalidone Chlorzoxazone Cholecalciferol Cholestyramine Choriogonadotropin Ciclesonide Cidofovir Cilastatin Cilazapril Cilostazol Cimetidine Cinacalcet Cinoxacin Ciprooxacin Cisapride Cisatracurium Cisplatin Citalopram Cladribine Clarithromycin Clavulanic acid Clemastine
26

Yes (NS) No (NS) No (NS) No (NS) Yes (NS) No (NS) No* (NS) U No (NS) ND U U U U ND Yes (NS) Yes (NS) U No (NS) No (NS) No (NS) No (NS) No (NS) U No (NS) No (8) ND ND Yes (NS) U

L U ND ND L U ND ND ND ND U U U U Yes (60) L L U ND U ND ND U ND Yes (NS) No (40) ND ND L U

No U No U No No No U U ND U U U U No ND ND U No No U No U U No U ND ND Yes U

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Clevidipine U Clinaoxacin No (6.4) Clindamycin No (NS) Clodronate ND Clofarabine ND Clofazimine No (NS) Clobrate No (NS) Clomiphene ND Clomipramine U Clonazepam No (NS) Clonidine No (NS) Clopidogrel U Clorazepate No (NS) Clotrimazole U Cloxacillin No (NS) Clozapine No (NS) Codeine/metabolites (morphine-3 No/Yes (NS) and morphine-6 glucuronides, codeine-6 glucuronide Colchicine No (NS) Colesevalam U Colestipol U Colistin No (NS) Collagenase clostridium U histolyticum Conivaptan U Cortisone No (NS) Cromolyn sodium U

U No (8.1, 8.8) ND Yes (8.1) ND ND U ND U ND ND ND ND U ND U

U ND No No ND No No ND U U No U U U No U

ND

ND U U ND U U ND U

No U U No U U No U
27

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Cyanocobalamin Cyclacillin Cyclobenzaprine Cyclophosphamide Cycloserine Cyclosporine Cyproheptadine Cystadane Cysteamine Cytarabine Dabigatran Dacarbazine Daclizumab Dactinomycin Dalbavancin Dalfampridine Dalteparin Danaparoid Dantrolene Dapsone Daptomycin Darbepoetin alfa Darifenacin Darunavir Dasatinib Daunorubicin Decitabine Deferasirox Deferoxamine Deazacort
28

No (NS) Yes (NS) U Yes (6.4) ND No (NS) ND ND ND ND Yes (NS) ND U ND No (NS) ND U ND ND Yes (NS) No (11) U U Yes (NS) U ND ND U Yes (NS) No (NS)

No (40, 65) L U L Yes (30, 52) U ND ND ND Yes (NS) L ND ND ND ND L ND ND ND L Yes (62) No (11.1-55) U L U ND ND U L ND

ND No U ND ND No ND ND No No ND ND U ND U ND No ND ND ND No No U U U ND ND U ND U

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Degarelix Delavirdine Demeclocycline Denileukin Denosumab Desipramine Desloratadine Desmopressin Desogestrel Desvenlafaxine Dexamethasone Dexchlorpheniramine Dexfenuramine Dexmedetomidine Dexmethylphenidate Dexrazoxane Dextroamphetamine Dezocine Diatrizoate Diazepam Diazoxide Dibekacin Diclofenac Dicloxacillin Dicyclomine Didanosine Diethylpropion Diethylstilbesterol (fosfestrol) Diunisal

U U ND U U No (NS) No (NS) ND U No (NS) No (NS) Yes (NS) ND U ND ND ND ND L No (NS) Yes (NS) Yes (NS) U No (NS) ND No (7.9) ND No (NS) No (NS)

U ND ND U U ND ND ND U U ND L ND U ND ND ND ND Yes (NS) ND L L ND ND ND No (40) ND ND ND

U U ND U U No No ND U U No No ND U ND ND ND ND ND U Yes ND U No ND No ND ND U
29

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Digitoxin Digoxin Digoxin immune Fab Dihydrocodeine Dihydroergotamine Diltiazem Dimenhydrinate Dimyristoyl lecithin Dinoprostone Diphenhydramine Diphenoxylate/ Atropine Dipyridamole Dirithromycin Disopyramide Disulram Divalproex Dobutamine Docetaxel Dofetilide Dolasetron Domperidone Donepezil Dopamine Doripenem Dornase alfa Doxacurium Doxapram Doxazosin Doxepin
30

No (NS) No (NS) No (NS) ND ND No (NS) ND ND ND U ND U No (NS) No (NS) U No (NS) No (NS) No (NS) ND ND U U No (NS) Yes (NS) U No (NS) ND No (NS) No (NS)

ND ND U ND ND ND ND ND ND ND ND ND ND U U ND ND U ND ND U ND ND ND U ND ND ND ND

No No No ND ND No ND ND ND U ND ND No U U No No U ND ND U U U ND U U ND No No

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Doxercalciferol Doxorubicin Doxycycline Doxylamine Dronabinol Dronedarone Droperidol Drosperinone Drotrecogin alfa Duloxetine Dutasteride Ecallantide Eculizumab Edetate calcium (ETDA) Edrophonium Efalizumab Efavirenz Eletriptan Eltrombopag Emtricitabine Enalapril (enalaprilat) Encainide Enfuvirtide Enoxacin Enoxaparin Entacapone Entecavir Enfuvirtide Ephedrine

No (NS) No (NS) No (NS) ND U U U U U U U ND U Yes (NS) ND U No (NS) ND ND Yes (NS) Yes (NS) No (NS) No (NS) No (NS) No (NS) U No (NS) No (NS) ND

U ND ND ND ND U ND U U U U ND U L ND U ND ND ND ND L ND U ND Yes (11.5-55) U ND U ND

U ND No ND U U U U U U U ND U Yes ND U No ND ND ND Yes ND U No No U No U ND
31

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Epinephrine Epirubicin Eplerenone Epoetin alfa Epoprostenol Eprosartan Eptacog alfa Eptibatide Ergocalciferol Ergotamine Erlotinib Ertapenem Erythromycin Escitalopram Eslicarbazine Esmolol (ASL-8123) Esomeprazole Estazolam Estradiol Estramustine Estrogens, conjugated Estrone Estropipate Eszopiclone Etanercept Ethacrynic acid Ethambutol Ethanolamine oleate Ethchlorvynol Ethinyl estradiol
32

ND ND No (7) No (NS) ND U U ND ND ND U Yes (NS) No (NS) ND Yes (NS) Yes (NS) U U No (NS) ND ND No (NS) U ND No (NS) No (NS) No (NS) ND No* (NS) U

ND ND ND No (11.1-55) ND No (60) U ND ND ND No (NS) L ND ND L L U U U ND ND ND U ND U U No (80) ND ND U

ND ND ND No ND U U ND ND ND U ND No ND ND Yes U U U ND ND ND U ND U U U ND No No

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Ethionamide Ethosuximide Ethotoin Etidronate Etodolac Etonogestrel Etoposide Etoricoxib Etravirine Everolimus Exemestane Exenatide Ezetimibe Famciclovir (penciclovir) Famotidine Febuxostat Felbamate Felodipine Fenuramine Fenobrate Fenoldopam Fenoprofen Fentanyl Ferric gluconate Ferrous (iron) salts Ferumoxytol Fesoterodine Fexofenadine Filgrastim

U Yes (NS) ND ND No (NS) ND No (NS) No (NS) No (NS) ND U ND U Yes (NS) No (NS) U ND No (NS) ND No (NS) U No (NS) U No (NS) U No (NS) ND No (NS) No (NS)

No (30, 52) L ND ND U ND No (NS) U U ND U ND U L ND U ND U ND U ND U No (10.1) ND ND ND ND ND ND

U ND ND ND U ND No U U ND U ND U ND No U ND U ND U No U ND U U ND ND U U
33

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Finasteride U ND Flavoxate ND ND Flecainide No (NS) ND Fleroxacin U No (8.1, 22) Floxuridine ND ND Fluconazole Yes (NS) L Flucytosine Yes (NS) L Fludarabine ND ND Fludrocortisone ND ND Flumazenil ND ND Fluorouracil/FBAL No (NS)/ND Yes (71)/Yes (40) Fluoxetine No (NS) U Fluoxymesterone ND ND Fluphenazine U ND Flurazepam No (NS) ND Flurbiprofen U U Flutamide No (NS) ND Fluticasone U U Fluvastatin No (NS) U Fluvoxamine U No (NS) Folic acid Yes (NS) L Follitropin alfa ND ND Follitropin beta ND ND Fomepizole Yes (NS) L Fondaparinux No (NS) ND Fosamprenavir U U Fosaprepitant No (NS) U Foscarnet Yes (4.1) Yes (18-60) Fosfomycin Yes (NS) L Fosinopril (fosinoprilat) No (NS) ND
34

U ND U No ND Yes Yes ND ND ND ND No ND U U No U U U U ND ND ND ND U U U ND ND No

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Fosphenytoin Frovatriptan Fulvestrant Furosemide Fusidic acid Gabapentin Gadobenate Gadobutrol Gadodiamide Gadolinium Gadopentetate Gadoteridol Gadoversetamide Gadoxetate Galantamine Gallium Gallopamil Galsulfase Ganciclovir Ganirelix Garenoxacin Gatioxacin Geftinib Gemcitabine Gembrozil Gemioxacin Gemtuzumab Gentamicin Gestodene Glatiramer

U ND U No (NS) No (NS) Yes (NS) ND Yes (5.5) Yes (NS) Yes (NS) Yes (NS) ND ND Yes (NS) ND ND U U Yes (NS) ND No (NS) ND U Yes (7) No (NS) No (NS) U Yes (NS) U ND

U ND U U ND L ND L L ND L ND Yes (NS) L ND ND U U L ND ND ND No (20) Yes (53, 58) U ND U Yes (13.2-60) U ND

U ND U U No ND ND ND No ND ND ND ND ND ND ND U U ND ND No ND U ND No ND U Yes U ND
35

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Gliclazide Glimepiride Glipizide Glucagon Glutethimide Glyburide Glycopyrrolate Gold sodium thiomalate Golimumab Goserelin Granisetron Grepaoxacin Griseofulvin Guaifenesin Guanabenz Guanadrel Guanethidine Guanfacine Guanidine H1N1 Vaccine Halofantrine Haloperidol Heparin Hexobarbital Hirudin Human Growth Hormone Hydralazine Hydrochlorothiazide

U U U U No* (NS) No (NS) ND No (NS) U ND ND ND ND ND U ND ND No (NS) ND ND ND No (NS) No (NS) No (NS) No (4.3-6.5) U No (NS) No (NS)

U U U ND ND U ND ND U ND ND ND ND ND U ND ND ND ND ND ND U ND ND Yes (20-90) U ND ND

U U U U No U ND U U ND ND ND ND ND U ND ND No ND ND ND No No U ND U No U

36

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Hydrocodone ND Hydrocortisone U Hydromorphone/ hydromorphone-3No/Yes (7.5) glucuronide Hydroxychloroquine ND Hydroxyurea No (NS) Hydroxyzine No (NS) Ibandronate ND Ibritumomab U Ibuprofen No (NS) Ibutilide ND Idarubicin U Idebenone U Idursulfase U Ifosfamide Yes (1.6) Iloperidone U Iloprost ND Imatinib No (NS) Imidapril (imidaprilat) No (NS) Imiglucerase U Imipenem Yes (NS) Imipramine No (NS) Immune globulin U Indapamide No (NS) Indinavir U Indomethacin No (NS) Iniximab U Insulin No (NS) Insulin aspart U

ND ND ND ND ND U Yes (8.1) U U ND U U U L U ND U U U L U ND ND No (40) U U ND ND

ND U U ND U No ND U U ND U U U ND U ND U U U Yes No U U ND U U No U

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

37

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Insulin detemir No (NS) U Insulin glargine U ND Insulin glulisine U ND Insulin lispro U ND Interferons No (NS) Yes (20-33) Iobenguane No (NS) ND Iodipamide ND ND Iodixanol Yes (3.1, 4.2) L Iohexol Yes (NS) Yes (15.5) Iomeprol Yes (6.8) L Iopamidol Yes (4.8) L Iopromide Yes (5.5-6.8) Yes (8.1-62) Iotrolan Yes (NS) L Ioversol Yes (6.3) L Ioxaglic acid L Yes (15.5) Ioxilan Yes (NS) L Ioxitalamic acid ND ND Irbesartan No (NS) ND Irinotecan U/U No (8.5)/L (SN-38 metabolite) Iron dextran U No (8.1-10.1) Iron sucrose U No (11.1-55) Isocarboxazid ND ND Isoniazid No (NS) No (80) Isoproterenol ND ND Isosorbide dinitrate No (NS) ND Isosorbide mononitrate Yes (NS) L Isotretinoin U U Isradipine No (NS) U Itraconazole No (NS) No (65)
38

ND U ND U No ND ND ND ND Yes Yes ND ND ND ND ND ND ND U/U U U ND No ND No No U No U

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Ivermectin ND Ixabepilone ND Kanamycin Yes (NS) Ketamine No (NS) Ketoconazole No (NS) Ketoprofen U Ketorolac U Ketotifen ND Labetolol No (NS) Lacosamide No (NS) Lactulose U Lamivudine No (NS) Lamotrigine No (NS) Lanreotide ND Lansoprazole No (NS) Lanthanum carbonate No (NS) Lapatinib U Laronidase U Leunomide No (NS) Lenalidomide Yes (NS) Lepirudin No (4.3-6.2) Letrozole ND Leucovorin ND Leuprolide ND Levamisole ND Levetiracetam Yes (NS) Levobupivacaine U Levocarnitine Yes (NS) Levocetirizine No (NS) Levodopa U

ND ND L ND ND U U ND ND ND U No (11.4) ND ND U U U U No (8.1) ND Yes (20-90) ND ND ND ND L ND L U U

ND ND Yes U No U U ND No U U No U ND U U U U No ND ND ND ND ND ND ND U ND U U
39

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Levooxacin Levoleucovorin Levomethadyl Levonorgestrel Levorphanol Levosimendan Levothyroxine Lidocaine Lincomycin Linezolid Liothyronine Liraglutide Lisdexamfetamine Lisinopril Lithium Lomeoxacin Lomustine Loperamide Lopinavir Loracarbef Loratadine Lorazepam Losartan Lovastatin Loxapine L-tryptophan Lubiprostone Lumefantrine Mangafodipir Mannitol
40

U ND U U ND No (6.4) U No (NS) No (NS) Yes (NS) ND U ND Yes (NS) Yes (NS) No (NS) No (NS) ND U Yes (NS) No (NS) No (NS) No (NS) U ND U U ND ND Yes (NS)

No (13.2) ND U ND ND U ND ND ND Yes (9.3-65) ND U ND L Yes (40, 70) ND ND ND No (NS) L U ND No (10.1-52) U ND No (8.1-40) U ND ND L

No ND U U ND U U U No ND ND U ND ND Yes No U ND U ND No U No U ND ND U ND ND Yes

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Maprotiline No (NS) U Maraviroc ND ND Mecamylamine ND ND Mecasermin ND ND Mechlorethamine U U Meclofenamate U U Medroxyprogesterone U U Mefenamic acid No (NS) U Meoquine U ND Megestrol acetate ND ND Melatonin/6Yes (NS) L sulfatoxymelatonin Meloxicam No (NS) U Melphalan No (NS) ND Memantine ND ND Menadiol ND ND Menotropins ND ND Mepenzolate ND ND Meperidine/ No (NS)/ND No (8.1)/Yes (8.1) normeperidine Meprobamate Yes (NS) L Mercaptopurine Yes (NS) L Meropenem Yes (NS) L Mesalamine (5-ASA) Yes (5.5) ND Mesna ND ND Mesoridazine U ND Metaproterenol ND ND Metaxalone ND ND Metformin Yes (NS) L Methadone No (NS) U

U ND ND ND U U U U U ND ND U ND ND ND ND ND U/ND Yes ND ND U ND U ND ND ND No

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

41

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Methaqualone Methenamine Methicillin Methimazole Methocarbamol Methohexital Methotrexate Methoxsalen Methoxypolyethylene glycol-epoetin beta Methscopolamine Methsuximide Methyl aminolevulinate HCl Methyldopa Methylergonovine Methylnaltrexone Methylphenidate Methylprednisolone Methysergide Metoclopramide Metolazone Metoprolol Metronidazole Mexiletine Mezlocillin Micafungin Miconazole Midazolam

No (NS) ND No (NS) No (NS) ND U Yes (NS) ND U ND ND U Yes (NS) ND ND U Yes (NS) ND No (NS) No (NS) Yes (NS) Yes (NS) Yes (NS) Yes (NS) U No (NS) No (NS)

ND ND U ND ND U Yes (20, 60) ND U ND ND U L ND ND ND L ND U U L Yes (56) L L U U U

No ND No No ND U Y ND U ND ND U Yes ND ND U ND ND No U ND No No No U No U

42

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Midodrine (de-glymidodrine) Mifepristone Miglitol Miglustat Milnacipran Milrinone Minocycline Minoxidil Mirtazapine Misoprostol Mitomycin Mitotane Mitoxantrone Mivacurium Modanil Moexipril Molindone Montelukast Moricizine Moroctocog alfa Morphine Moxioxacin Muromonab-CD3 Mycophenolate (mycophenolic acid) Nabilone Nabumetone Nadolol Nadroparin

ND U ND ND U ND No (NS) Yes (NS) No (7.5) U ND ND No (NS) ND ND ND U U U U ND ND U No (NS) ND No (NS) Yes (NS) ND

Yes (8.1) U ND ND U ND ND L ND ND ND ND U ND ND ND ND ND ND U Yes (8.1, 10.1) ND ND U ND U L ND

ND U ND ND U ND No Yes U U ND ND No ND ND ND U U U U No No U No ND U ND ND
43

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Nafarelin Nafcillin Nalbuphine Nalidixic acid Nalmefene Naloxone Naltrexone Nandrolone Naproxen Naratriptan Natalizumab Nateglinide/ M1 metabolite Nebivolol Nedocromil Nefazodone Nelarabine Nelnavir Neomycin Nesiritide Netilmicin Nevirapine Niacin Niacinamide Nicardipine Nicotine Nicotinic acid Nifedipine Nilotinib Nilutamide
44

ND No (NS) ND U No (4.1-5.9) ND No (NS) ND No (NS) ND U U/Yes (NS) U ND U U U Yes (NS) U Yes (NS) ND ND ND No (NS) ND ND No (NS) U ND

ND ND ND U U ND U ND U ND U U/Yes (NS) U ND U U No (71) L U L Yes (40) ND ND U ND ND U U ND

ND No ND U U ND U ND U ND U U/ND U ND U U No Yes U Yes Yes ND ND U ND ND No U ND

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Nimodipine Nisoldipine Nitazoxanide Nitrendipine Nitrofurantoin Nitroglycerin Nitroprusside Nizatidine Nomifensine Nonacog alfa Norepinephrine Norethindrone Noroxacin Norgestimate Norgestrel Nortriptyline Nylidrin Nystatin Octreotide Ofatumumab Ooxacin Olanzapine Olmesartan Olsalazine Omapatrilat Omega-3-acid ethyl esters Omeprazole Ondansetron Oprelvekin

No (NS) No (NS) U No (NS) Yes (NS) No (NS) Yes (NS) No (NS) ND U ND ND No (NS) U ND No (NS) ND U Yes (NS) U Yes (6.0) No (NS) U U No (NS) ND U U U

U U U U L ND L ND ND U ND ND ND U ND U ND U L U Yes (8.5) U No (NS) ND ND ND ND ND U

No No U U ND No Yes No ND U ND No U U ND No ND U ND U No No U U ND ND U U U
45

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Orboban Yes (NS) Orlistat U Ornidazole Yes (NS) Ornipressin U Orphenadrine ND Oseltamivir Yes (2.8-4.0) Oxacillin No (NS) Oxaliplatin ND Oxandrolone U Oxaprozin No (NS) Oxazepam No (NS) Oxcarbazepine ND Oxtriphylline Yes (NS) Oxybutynin ND Oxycodone ND Oxymetholone ND Oxymorphone U Paclitaxel No (NS) Palifermin U Paliperidone ND Palivizumab U Palonosetron ND Pamidronate Yes (6.4) Pancuronium ND Panitumumab U Pantoprazole No (5.1) Papaverine U Para-aminosalicylate U Paricalcitol No (5.5) Paromomycin ND
46

L U L U ND L U Yes (71) U ND ND ND L ND Yes (48) ND U U ND ND U ND L ND U U U No (30, 60) ND ND

ND U No U ND Yes No ND U U U ND No ND ND ND U No ND ND U ND ND ND U U U U ND ND

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Paroxetine Pazopanib Peoxacin Pegademase Pegaspargase Peglgrastim Peginterferon alfa-2a Peginterferon alfa-2b Pegvisomant Pemetrexed Pemoline Penbutolol Penicillamine Penicillin Pentamidine Pentazocine Pentobarbital Pentosan polysulfate Pentostatin Pentoxifylline Perexane Perutren Pergolide Perindopril (perindoprilat) Perphenazine Phenacetin Phenazopyridine Phendimetrazine

No (NS) U No (NS) U U No (NS) U U U ND Yes (NS) No (NS) Yes (NS) Yes (NS) No (NS) Yes (NS) No (NS) ND ND U ND ND U Yes (NS) U ND ND ND

U U ND U ND U No (8.7-33) No (8.7) Yes (20-33) U ND L ND L L ND L ND ND ND U ND ND U L U ND ND ND

U U No U U U U U U ND No No ND No No ND U ND ND U ND ND U ND U ND ND ND
47

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Phenelzine Phenobarbital Phenoxybenzamine Phentermine Phentolamine Phenylbutazone Phenytoin Phytonadione Pilocarpine Pimozide Pinaverium Pindolol Pioglitazone Piperacillin Pitavastatin Piroxicam Pizotyline Plerixafor Plicamycin Pneumococcal vaccine Polidocanol Polyethylene glycol Polythiazide Poractant alfa Pormer Posaconazole Pralatrexate Pralidoxime Pramipexole
48

ND Yes (NS) ND ND ND No (NS) No (NS) ND ND ND U ND No (NS) Yes (NS) U U U ND ND ND ND U No (NS) ND No (NS) No (NS) ND ND No (NS)

ND Yes (60) ND ND ND U Yes (36) ND ND ND U ND U L U U U ND ND ND ND U ND ND U U ND ND U

ND Yes ND ND ND U No ND ND ND U ND U No U U U ND ND ND ND U No ND U U ND ND U

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Pramlintide ND Prasugrel U Pravastatin No (5.3) Prazepam No (NS) Praziquantel No (NS) Prazosin No (NS) Prednisolone U Prednisone No (NS) Pregabalin Yes (NS) Primaquine No (NS) Primidone Yes (NS) Probenecid U Probucol No (NS) Procainamide/N-acetyl Yes (NS)/ procainamide (NAPA) Yes (NS) Procarbazine ND Prochlorperazine U Procyclidine ND Progesterone U Proguanil No (NS) Promazine U Promethazine No (NS) Propafenone No (NS) Propantheline ND Propofol U Propoxyphene No (NS) Propranolol No (NS) Propylthiouracil No (NS) Protriptyline No (NS) Pseudoephedrine No (NS)
SEE DISCLAIMER REGARDING USE OF THIS GUIDE

ND U ND ND ND U No (NS) ND L U L U ND L/L ND U ND U U ND U U ND U ND U ND U U

ND U ND U ND No U No ND U ND U No No/No ND U ND U U U U No ND U No No ND No U
49

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Pyrantel Pyrazinamide Pyridostigmine Pyridoxine Pyrilamine Pyrimethamine Quazepam Quetiapine Quinapril (quinaprilat) Quinidine Quinine Quinupristin/ dalfopristin Rabeprazole Raloxifene Raltegravir Raltitrexed Ramelteon Ramipril (ramiprilat) Ranibizumab Ranitidine Ranolazine Rapacuronium Rasagiline Rasburicase Recainam Remifentanil Repaglinide Reserpine Reteplase
50

ND Yes (NS) ND ND ND ND U ND No (NS) No* (NS) No (NS) ND U U Yes (NS) ND ND No (NS) U No (NS) ND ND ND U No (NS) U U No (NS) ND

ND Yes (80) ND Yes (36) ND ND U ND U U U ND U U L ND ND ND U Yes (NS) ND ND ND U ND U No (60) U ND

ND No ND ND ND ND U ND No No No No/No U U ND ND ND ND U No ND ND ND U U U U No ND

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Reviparin Ribavirin Rifabutin Rifampin Rifapentine Rifaximin Rilmenidine Rilonacept Riluzole Rimantadine Risedronate Risperidone Ritodrine Ritonavir Rituximab Rivaroxaban Rivastigmine Rizatriptan Rocuronium Romidepsin Romiplostim Ropinirole Ropivacaine Rosiglitazone Rosuvastatin Rotigotine Roxithromycin Ruboxistaurin Runamide Ruoxacin

No (NS) No (NS) U No (NS) U U No (NS) U U No (NS) ND ND Yes (NS) Yes (NS) No (NS) ND ND ND ND U ND U U No (NS) No (NS) U ND U No (NS) ND

ND U No (40) No (80) U U ND U U U ND ND L L U ND ND ND ND U ND U U U ND U ND U ND ND

U U U No U U U U U U ND ND Yes No U ND ND ND ND U ND U U No U U No U U ND
51

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Sacrosidase Salsalate Sapropterin Saquinavir Sargramostim Saxagliptin Secobarbital Secretin Selegiline Sermorelin Sertindole Sertraline Sevelamer Sevourane Sibutramine Sildenal Silodosin Silver Simethicone Simvastatin Sirolimus Sisomicin Sitagliptin Sitaxsentan Sodium oxybate Sodium polystyrene sulfonate Solifenacin Somatropin Sorafenib
52

ND Yes (NS) ND U ND Yes (NS) No (NS) ND ND ND No (NS) No (NS) U ND U U U No (NS) U U No (NS) Yes (NS) No (NS) U ND U U No (NS) U

ND L ND No (40) ND Yes (NS) ND ND ND ND U U U ND U No (65) U ND U U U L ND U ND U U U U

ND No ND U ND ND No ND ND ND U U U ND U U U U U U U ND ND U ND U U U U

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Sotalol Sparoxacin Spectinomycin Spirapril (spiraprilat) Spironolactone Stanozolol Stavudine Streptokinase Streptomycin Sucralfate Sufentanil Sulbactam Sulfadiazine Sulfadoxine Sulfamethoxazole Sulfapyridine Sulfasalazine Sulnpyrazone Sulsoxazole Sulindac Sumatriptan Sunitinib Tacrine Tacrolimus Tadalal Talinolol Tamoxifen Tamsulosin Tapentadol Tazobactam

Yes (NS) ND Yes (NS) U U ND Yes (NS) U Yes (NS) No (NS) U Yes (NS) ND ND Yes (NS) ND U No (NS) Yes (NS) No (NS) ND U ND No (NS) No (NS) No (NS) ND U U Yes (NS)

L ND L ND ND ND Yes (NS) U L ND U L ND ND L ND U U L ND ND No (NS) ND U U ND ND U U L

ND ND Yes U U ND ND U Yes No U No ND ND No ND U U Yes U ND U ND U U ND ND U U No

53

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Tebazumab Tegaserod Teicoplanin Telavancin Telbivudine Telithromycin Telmisartan Temazepam Temocillin Temozolomide Temsirolimus Teniposide Tenofovir Terazosin Terbinane Terbutaline Teriparatide Testolactone Testosterone Tetrabenazine Tetracycline Thalidomide Thallous chloride Theophylline Thiabendazole Thiamine Thiethylperazine Thioguanine Thioproperazine Thioridazine
54

No (NS) No (NS) No (NS) ND No (NS) ND No (NS) No (NS) Yes (NS) ND No (NS) U ND No (NS) U ND ND ND No (NS) ND No (NS) U ND Yes (NS) ND No (NS) ND ND ND U

ND U ND L ND ND ND U L ND U ND Yes (50) U U ND ND ND U ND ND No (65) ND L ND ND ND ND ND U

U U No U ND ND U U No ND U U ND No U ND ND ND U ND No U ND No ND U ND ND ND U

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Thiotepa Thiothixene Thrombin alfa Thyrotropin alfa Tiagabine Ticarcillin Ticlopidine Tigecycline Tilidine Tiludronate Timolol Tinidazole Tinzaparin Tipranavir Tiroban Tizanidine Tobramycin Tocainide Tocilizumab Tocopherol Tolazamide Tolbutamide Tolcapone Tolmetin Tolterodine Tolvaptan Topiramate Topotecan Torsemide Tositumomab

ND U U U No (NS) Yes (NS) U No (NS) No (NS) U No (NS) Yes (NS) U U Yes (NS) ND Yes (NS) Yes (NS) ND ND U No (NS) U U U U Yes (NS) Yes (8.0) No (NS) U

ND ND U U U L U ND ND ND ND L ND U L ND L L ND ND ND ND U U U U L L U U

ND U U U U No U U U U No ND ND U ND ND Yes ND ND ND U U U U U U ND ND U U
55

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Tosuoxacin Tramadol Trandolapril (trandolaprilat) Tranexamic acid Tranylcypromine Trapidil Trastuzumab Trazodone Treprostinil Tretinoin Triamterene Triazolam Trientine Triuoperazine Triupromazine Trihexyphenidyl Trimeprazine Trimethobenzamide Trimethoprim Trimetrexate Trimipramine Triprolidine Triptorelin Tropisetron Trospium Trovaoxacin Ulipristal Urofollitropin Ursodiol
56

No (NS) No (NS) Yes (NS) ND ND ND U U U ND ND No (NS) ND No (NS) U ND ND ND Yes (NS) U U ND ND U ND No (NS) ND ND U

ND Yes (50) L ND ND ND U ND U ND ND ND ND U ND ND ND ND L U U ND ND U ND ND ND ND U

ND ND ND ND ND ND U U U ND ND U ND No U ND ND ND No U U ND ND U ND ND ND ND U

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Ustekinumab Valacyclovir Valganciclovir Valproic acid Valrubicin Valsartan Vancomycin Vardenal Varenicline Vecuronium Velaglucerase Velosulin Venlafaxine Verapamil Verteporn Vigabatrin Vildagliptin Vinblastine Vincristine Vinorelbine Voriconazole Vorinostat Warfarin Zarlukast Zalcitabine Zaleplon Zanamivir Zidovudine/GZDV Zileuton

ND Yes (NS) Yes (NS) No (NS) ND No (NS) No (NS) ND Yes (NS) U U U No (NS) No (NS) ND Yes (NS) ND ND ND ND No (NS) ND No (NS) U ND ND ND No (NS)/ Yes (NS) U

ND L ND Yes (62) ND ND Yes (10.1-60) ND ND ND U U U ND ND L ND ND ND ND No (NS) ND ND U ND ND ND ND/L No (8.3, 10.1)

ND No ND No ND U No ND ND U U U U No ND ND ND ND ND ND No ND No U ND ND ND No/Yes U
57

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

2011 Dialysis of Drugs

Drug

HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Zinc Ziprasidone Zoledronic acid Zolmitriptan Zolpidem Zonisamide Zuclopenthixol

ND No (NS) ND U No (NS) Yes (NS) ND

ND U ND U U ND ND

ND U ND U U ND ND

58

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

I CHART

Drugs of Abuse
HEMODIALYSIS Conventional High Permeability Peritoneal (KUf) (KUf) Dialysis

Drug

Amphetamine Cocaine Ethanol Heroin Lysergide (LSD) Marijuana (THC) MDMA (Ecstasy) Mescaline (peyote) Nicotine Phencyclidine (PCP) Psilocybin

ND No (NS) Yes (NS) U U U ND U ND U ND

ND ND L ND ND ND ND ND ND ND ND

ND U ND U U U ND U No U ND

SEE DISCLAIMER REGARDING USE OF THIS GUIDE

59

2011 Dialysis of Drugs

References
1. Aronoff GR, Bennett WM, Berns JS, Brier ME, Kasbekar N, Mueller BA, Pasko DA, Smoyer WE. Drug prescribing in renal failure, 5th ed. Philadelphia: American College of Physicians; 2007. 2. Choi G, Gomersall CD, Tian Q, Joynt GM, Freebairn R, Lipman J. Principles of antibacterial dosing in continuous renal replacement therapy. Crit Care Med. 2009;37:2268-2282. 3. Schetz M. Drug dosing in continuous renal replacement therapy: general rules. Curr Opin Crit Care. 2007;13:645-651. 4. Heintz BH, Matzke GR, Dager WE. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis. Pharmacotherapy. 2009;29:562-577. 5. Ibrahim RB, Liu C, Cronin SM, Murphy BD, Cha R, Swerdlow P, Edwards DJ. Drug removal by plasmapheresis: an evidence-based review. Pharmacotherapy. 2007;27:1529-1549. 6. Keller E, Reetze P, Schollmeyer P. Drug therapy in patients undergoing continuous ambulatory peritoneal dialysis: Clinical pharmacokinetic considerations. Clin Pharmacokinet. 1990;18:104-117. 7. Keller F, Bhler J, Czock D, Zellner D, Mertz AKH. Individualized drug dosage in patients treated with continuous hemoltration. Kidney Int. 1999;56 (Suppl 72):S-29- S31. 8. Bugge JF. Pharmacokinetics and drug dosing adjustments during continuous venovenous hemoltration or hemodialtration in critically ill patients. Acta Anaesthesiol Scand. 2001;45:929-934. 9. Olyaei AJ, Bennett WM. Principles of drug usage in dialysis patients, in Nissenson AR, Fine RN (eds). Handbook of Dialysis Therapy (4th ed). Philadelphia: Saunders Elsevier; 2008. 10. Taylor CA, Abdel-Rahman E, Zimmerman SW, Johnson CA. Clinical pharmacokinetics during continuous ambulatory peritoneal dialysis. Clin Pharmacokinet. 1996;31:293-308.

60

SEE DISCLAIMER REGARDING USE OF THIS GUIDE