Dosing of Antiretroviral Drugs in Adults with Renal Insufficiency and Hemodialysis

Drug	Standard Dosage	Dosing in Renal Insufficiency and Hemodialysis			References
Abacavir	300 mg PO BID	Dosage adjustment for renal insufficiency does not appear necessary			Ziagen package insert 5/07 (1)
Didanosine (enteric-coated capsules)	250 mg to 400 mg PO QD, depending on wt	ClCr (mL/min)	Wt ≥60 kg	Wt <60 kg	Videx EC package insert 11/06 (2, 3)
		≥60	400 mg QD	250 mg QD
		30-59	200 mg QD	125 mg QD
		10-29	125 mg QD	125 mg QD
		<10	125 mg QD	formulation not suitable
		HD	125 mg QD	formulation not suitable
Emtricitabine	200 mg PO QD	ClCr (mL/min)			Emtriva package insert 4/08
		≥50	200 mg QD
		30-49	200 mg Q 48 H
		15-29	200 mg Q 72 H
		<15	200 mg Q 96 H
		HD	200 mg Q 96 H, give dosage after dialysis
Lamivudine	150 mg PO BID or 300 mg PO QD	ClCr (mL/min)			Epivir package insert 2/08 (4, 5, 6)
		≥50	150 mg BID or 300 mg QD
		30-49	150 mg QD
		15-29	150 mg first dose, then 100 mg QD
		5-14	150 mg first dose, then 50 mg QD
		<5	50 mg first dose, then 25 mg QD
Stavudine	20 mg to 40 mg PO BID, depending on wt	ClCr (mL/min)	Wt ≥60 kg	Wt <60 kg	Zerit package insert 4/08 (7)
		>50	40 mg BID	30 mg BID
		26-50	20 mg BID	15 mg BID
		10-25	20 mg QD	15 mg QD
		HD	20 mg QD	15 mg QD
Tenofovir	300 mg PO QD	Experience in patients with ClCr <60 mL/min is limited. Preliminary data suggest:			Viread package insert 5/07 (8)
		ClCr (mL/min)
		≥50	300 mg QD
		30-49	300 mg Q 48 H
		10-29	300 mg twice weekly (ie, Q 3-4 days)
		HD	300 mg QW
Zidovudine	300 mg PO BID	ClCr (mL/min)			Retrovir package insert 11/06 (9, 10, 11)
		<15	100 mg Q 6-8 H
		HD	100 mg TID

Drug

Standard Dosage

Dosing in Renal Insufficiency and Hemodialysis

References

Abbreviations: BID = 2 times daily; ClCr = creatinine clearance; H = hours; HD = hemodialysis; PO = by mouth; Q = every; QD = 1 time daily; QHS = at bedtime; QW = once a week; TID = 3 times daily; Wt = weight

Atripla (efavirenz/emtricitabine/ tenofovir)

1 tab PO QHS

Substitute component drugs, adjusting dosage of each drug for ClCr

Atripla package insert 2/08

Combivir (zidovudine/lamivudine)

1 tab PO BID

Substitute component drugs, adjusting dosage of each drug for ClCr

Combivir package insert 4/07

Epzicom or Kivexa (abacavir/lamivudine)

1 tab PO QD

Substitute component drugs, adjusting dosage of each drug for ClCr

Epzicom package insert 5/07

Trizivir (zidovudine/lamivudine/abacavir)

1 tab PO BID

Substitute component drugs, adjusting dosage of each drug for ClCr

Trizivir package insert 5/07

Truvada (emtricitabine/tenofovir)

1 tab PO QD

ClCr (mL/min)

Truvada package insert 5/07

≥50

1 tab QD

30-49

1 tab Q 48 H

<30

Substitute component drugs, adjusting dosage of each drug for ClCr