Not On Dialysis - CrCl <50 mL/min
Administer 100% of indication specific dose
Reduce indication specific dose by 50%
No dose adjustment required
Intermittent Hemodialysis (IHD)
Administer 100% of indication specific dose
100% of dose three times weekly after dialysis
OR
50% of the dose q24h; administer dose after dialysis on dialysis days
No dose adjustment required