Disclaimer: Not intended to be official medical advice. Please consult your physician before starting any new medications.
Therapeutic drug monitoring to guide dose adjustment is recommended in the follow circumstances:
— Patients with LBW >90
— Patients with suspected or proven malabsorption
— Other forms of renal replacement (e.g. peritoneal dialysis), doses are administered 3 times per week in conjunction with therapeutic drug monitoring
If the patient’s Serum Creatinine(SCr) suggests eGFR is less than 30 (if input is SCr, eGFR calculated per Cockroft-Gault equation), OR if the patient is on renal replacement therapy, the dosing is the same mg per dose, but given less frequently according to method of renal replacement. If on intermittent hemodialysis, doses are timed after each HD session. For other forms of renal replacement (e.g. peritoneal dialysis), the doses are timed 3 times a week