The Renal Drug Handbook 4th Edition PDF

The Renal Drug Handbook 4th Edition PDF



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Preface

Welcome to the fourth edition of Th e Renal Drug Handbook. Th e information contained in this book 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.
The Handbook aims to:
● provide healthcare professionals with a single reference of easily retrievable, practical information relating to drug use, sourced from the practical experience of renal units throughout the UK. By referring to the monographs, the user is guided in how to prescribe, prepare and administer the drug with due regard to potentially serious drug interactions and to any renal replacement therapy the patient may be undergoing
● provide a practice- based review of drug utilisation in renal units across the UK, indicating, where appropriate, any local methods of use, licensed or otherwise. In recent years, the classification for chronic kidney disease (CKD) has changed, now being described as CKD stages 1–5. Each stage is defi ned by the patient’s eGFR (or estimated GFR), which is calculated using the MDRD (modifi cation of diet in renal disease) equation. One point to note is that the eGFR is normalised to a standard body surface area of 1.73 m2. Th ere is relatively good correlation between the two equations for calculating renal function in patients of average weight, and either could be used for the majority of drugs. However, eGFR should not be used for calculating drug doses in patients at extremes of body weight nor for drugs with a narrow therapeutic window unless it is first corrected to the actual GFR for that patient. Actual GFR can be calculated from the following equation:
Actual GFR = (eGFR × BSA/1.73)
At extremes of body weight neither the MDRD nor the Cockcroft- Gault equation is particularly accurate. If an accurate GFR is required, e.g. for chemotherapy, then an isotope GFR determination should be performed.
The information on dosage adjustments in renal impairment given in this book is based on Cockcroft- Gault creatinine clearance and not eGFR, since the majority of published information available is based on creatinine clearance.
Th e Handbook is not intended to off er definitive advice or guidance on how drugs should be used in patients with renal impairment, nor is it a comprehensive and complete list of all drugs licensed in the UK.
The range of drugs covered will continue to grow with subsequent editions. The Handbook is not a guide to diagnosis nor to a drug’s side- effect profile, except where adverse drug events are more pronounced in the presence of renal impairment. For more in- depth information, users are advised to refer to the Summary of Product Characteristics, the British National Formulary, package inserts or other product data.


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