The Renal Drug Handbook, 3rd Edition

Product Information

Summary of Product Characteristics: Terbinafine 250 mg tablets. Kent Pharmaceuticals UK Ltd. Revised March 2016. Oropharyngeal and oesophageal candidiasis: 200mg to 400mg loading dose on first day followed by 100mg to 200mg daily. Pharmacokinetics: Basic pharmacokinetic data such as molecular weight, half-life, percentage protein-binding, volume of distribution and percentage excreted unchanged in the urine are quoted, to assist in predicting drug handling in both renal impairment and renal replacement therapy. Use with caution in patients with glucose-6-phosphate dehydrogenase deficiency as there may be a risk of haemolysis in these patients. Bennett WM, et al. Drug Prescribing in Renal Failure: Dosing guidelines for adults. 5 th ed. American College of Physicians; 2007.

Summary of Product Characteristics: Spironolactone Tablets 25mg. Actavis UK Ltd. Revised June 2014. The duration of treatment for most patients is between 6 weeks and 3 months. For fingernail infections, toenail infections (except the big toe) and younger aged patients, treatment periods of less than 3 months can be anticipated. For toenail infection, 3 months is usually sufficient although longer therapy duration of up to 6 months may be required. Poor nail outgrowth in the first weeks of treatment may indicate those patients requiring longer treatment. Summary of Product Characteristics: Spironolactone Tablets 100mg. Actavis UK Ltd. Revised June 2014. Dose in renal impairment: The level of renal function below which the dose of a drug must be reduced depends largely on the extent of renal metabolism and elimination, and on the drug’s toxicity. Most drugs are relatively well tolerated, have a broad therapeutic index or are metabolised and excreted hepatically, so precise dose modification is unnecessary. In such cases, the user is instructed to ‘dose as in normal renal function’.

Footnotes

Treatment given for seven to fourteen days in oropharyngeal candidiasis (longer if required in severely immunocompromised patients).

The manufacturer does not recommend the use of standard doses or short-term use of fluconazole during pregnancy unless clearly necessary. The manufacturer also recommends that fluconazole should not be used during pregnancy for high or prolonged doses unless in cases of potentially life-threatening infections. The manufacturer recommends a washout period of around 1 week after a single-dose or discontinuation of a course of treatment before becoming pregnant. Invasive candidiasis: 800mg on day 1, followed by 400mg daily. Treatment duration for candidaemia is two weeks after first negative blood culture result and resolution of signs and symptoms of infection. The manufacturer recommends a washout period of around 1 week after a single-dose or discontinuation of a course of treatment before becoming pregnant. Pregnancy and Lactation Pregnancy

Schrier RW, Gambertoglio JG. Handbook of Drug Therapy in Liver and Kidney Disease. Little, Brown and Co.; 1991.

Welcome to the The Renal Drug Database. The information contained in this resource has been compiled from a wide range of sources and from the clinical experience of the editorial board of the UK Renal Pharmacy Group, all of whom are involved in the pharmaceutical care of renally-impaired patients. As such, some of the information contained in the monographs may not be in accordance with the licensed indications or use of the drug.If urinary Na+/K+ ratio is greater than 1, give 100mg daily. If the ratio is less than 1, give 200mg to 400mg daily.

Patients who have previously experienced adverse reactions to quinine including that in tonic water or other beverages should not be prescribed quinine. Pregnancy and Lactation Pregnancy Hepatotoxicity (including fatalities) has been observed during treatment but the abnormalities have usually been reversible on discontinuation of fluconazole. Patients who develop abnormal liver tests should be monitored for the development of more serious hepatic injury. Discontinue treatment if clinical signs or symptoms consistent with liver disease develop during treatment. individual medicine monographs on how to prescribe, prepare and administer the medicine in various types of renal impairment Physicochemical Principles of Pharmacy in Manufacture, Formulation and Clinical Use - 6th ed. (2016)

Summary

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management. Tinea unguium (onychomycosis): 150mg once weekly. Treatment should be continued until uninfected nail grows. Usually three to six months for fingernails and six to twelve months for toenails. Vaginal candidiasis prophylaxis and treatment (four or more episodes yearly): 150mg every 72 hours for three doses followed by 150mg once weekly maintenance dose for six months.