Abstract
The principles of drug dosing in renal failure relate to the concept of individualization of drug therapy. The goal of this concept is to achieve the desired intensity of drug effect in the patient being treated. Dosage adjustment to produce the “therapeutic drug level” has become the major means to achieve this goal. The reason that this is usually effective is that most of the individual variation in dose-response is due to variation between individuals in their rates of elimination of drugs, not in their receptor or tissue sensitivity to drugs. Thus, individualizing dose to produce the desired drug level leaves only the variation in tissue sensitivity to affect the intensity of a drug’s effect.
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References
Craig RM, Murphy P, Gibson TP, Quintanilla A, Chao C, Cochrane C, Patterson A, Atkinson AJ. Kinetic analysis of D-xylose absorption in normal subjects and in patients with chronic renal failure. J Lab Clin Med 1983; 101: 496–506.
Boobis SW. Alteration of plasma albumin in relation to decreased drug binding in uremia. Clin Pharmacol Ther 1978; 22: 147–53.
Wood AJJ, Zhou HH. Ethnic differences in drug disposition and responsiveness. Clin Pharmacokinetics 1991; 20: 350–73.
Brosen L. Recent developments in hepatic drug oxidation. Clin Pharmacokinet 1990; 18: 220–39.
Reidenberg MM, Affrime M. Influence of disease on binding of drugs to plasma proteins. Ann NY Acad Sci 1973; 226: 115–26.
Reidenberg MM. The biotransformation of drugs in renal failure. Am J Med 1977; 62: 482–5.
Gibson TP. Renal disease and drug metabolism: an overview. Am J Kidney Dis 1986; 8: 7–17.
Drayer DE. Pharmacologically active drug metabolites: therapeutic and toxic activities, plasma and urine data in man, accumulation in renal failure. Clin Pharmacokinet 1976; 1: 426–43.
Drayer DE, Lowenthal DT, Woosley RL, Nies AS, Schwartz A, Reidenberg MM. Cumulation of N-acetylprocainamide, an active metabolite of procainamide, in patients with impaired renal function. Clin Pharmacol Ther 1977; 22: 63–9.
Szeto HH, Inturrisi CE, Houde R, Saal S, Cheigh J, Reidenberg MM. Accumulation of normeperidine, an active metabolite of meperidine, in patients with renal failure or cancer. Ann Intern Med 1977; 86: 738–41.
Kaiko RF, Foley KM, Grabinski PY, Heidrich G, Rogers AG, Inturrisi CE, Reidenberg MM. Central nervous system excitatory effects of meperidine in cancer patients. Ann Neurology 1983; 13: 180–5.
Dettli L, Spring P, Ryter S. Multiple dose kinetics and drug dosage in patients with kidney disease. Acta Pharmacol et Toxicol 1971; 29 (suppl 3): 211–24.
Dundee JW, Richards RK. Effect of azotemia upon the action of intravenous barbiturate anesthesia. Anesthesiology 1954; 15: 333–46.
Mak RH, DeFronzo RA. Glucose and insulin metabolism in uremia. Nephron 1992; 61(4): 377–82.
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Reidenberg, M.M. (1998). Principles of drug dosing in renal failure. In: De Broe, M.E., Porter, G.A., Bennett, W.M., Verpooten, G.A. (eds) Clinical Nephrotoxins. Springer, Dordrecht. https://doi.org/10.1007/978-94-015-9088-4_36
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DOI: https://doi.org/10.1007/978-94-015-9088-4_36
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-015-9090-7
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