🫘 Renal Dose Adjustment Quick Reference
Quick reference for adjusting common renally-cleared drugs by CrCl/eGFR — DOACs, metformin, enoxaparin, gabapentinoids, NSAIDs and more. Browser-side.
Thresholds change with label updates — always verify the current label.
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When to use
Bedside reminder of renal thresholds and adjustments for 13 commonly used drugs. Not exhaustive — confirm against the latest label.
How it works
Per-drug bands by CrCl/eGFR (e.g. metformin contraindicated < 30; apixaban 2.5 mg BID if ≥ 2 of age ≥ 80 / weight ≤ 60 kg / SCr ≥ 1.5).
Key points
- Thresholds change with label updates — always verify the current label.
- Match the renal-function method (Cockcroft-Gault vs CKD-EPI) to the drug's PK studies.
- NSAIDs: avoid below eGFR 30 and beware the ACEI/ARB + diuretic 'triple whammy'.
- Individualise to the whole patient and institutional protocol.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Drug | Metformin |
|---|
→Renal key pointeGFR < 30 contraindicated
- eGFR ≥ 45：Usual dose
- eGFR 30–45：Do not start new; if already on, weigh risk/benefit and consider reducing (e.g. 500 mg qd)
- eGFR < 30：Contraindicated (lactic acidosis risk)
| Drug | Digoxin |
|---|
→Renal key pointReduce + monitor as renal function falls
- Excretion：Mainly renal; reduce as renal function falls
- Monitoring：Drug level (HF target 0.5–0.9 ng/mL)
- Potentiation：Hypokalaemia/hypomagnesaemia increase digoxin toxicity
Frequently asked questions
- What is Renal Dose Adjustment Quick Reference?
- Quick reference for adjusting common renally-cleared drugs by CrCl/eGFR — DOACs, metformin, enoxaparin, gabapentinoids, NSAIDs and more. Browser-side.
- How is Renal Dose Adjustment Quick Reference calculated? What is the core formula?
- Per-drug bands by CrCl/eGFR (e.g. metformin contraindicated < 30; apixaban 2.5 mg BID if ≥ 2 of age ≥ 80 / weight ≤ 60 kg / SCr ≥ 1.5).
- When is Renal Dose Adjustment Quick Reference used?
- Bedside reminder of renal thresholds and adjustments for 13 commonly used drugs. Not exhaustive — confirm against the latest label.
- What are the key clinical points for Renal Dose Adjustment Quick Reference?
- Thresholds change with label updates — always verify the current label. Match the renal-function method (Cockcroft-Gault vs CKD-EPI) to the drug's PK studies. NSAIDs: avoid below eGFR 30 and beware the ACEI/ARB + diuretic 'triple whammy'. Individualise to the whole patient and institutional protocol.
- What are the limits and cautions when using Renal Dose Adjustment Quick Reference?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Renal Dose Adjustment Quick Reference calculated in practice? Can you show a worked example?
- Inputs: Drug Metformin → Result: Renal key point eGFR < 30 contraindicated（eGFR ≥ 45: Usual dose, eGFR 30–45: Do not start new; if already on, weigh risk/benefit and consider reducing (e.g. 500 mg qd), eGFR < 30: Contraindicated (lactic acidosis risk)） Inputs: Drug Digoxin → Result: Renal key point Reduce + monitor as renal function falls（Excretion: Mainly renal; reduce as renal function falls, Monitoring: Drug level (HF target 0.5–0.9 ng/mL), Potentiation: Hypokalaemia/hypomagnesaemia increase digoxin toxicity）