In the setting of rapidly improving or worsening renal function, calculations of CrCl are inaccurate. Dosing should be based on estimated renal function instead.
If improving renal function, actual CrCl is likely higher than calculated CrCl.
If worsening renal function, actual CrCl is likely lower than calculated CrCl.
Not On Dialysis
30 mg PO q48h
30 mg PO q24h
30 mg PO q12h
Intermittent Dialysis
30 mg PO load, then 30 mg PO after each HD session for 5 day period
Continuous Dialysis
75 mg PO q24h