In the setting of rapidly improving/worsening renal function, calculations of CrCl are inaccurate, and dosing should be based on estimated renal function instead.
If worsening renal function, actual CrCl is likely lower than calculated.
If improving renal function, actual CrCl is likely higher than calculated CrCl.
Not On Dialysis
500mg PO q12-24h
500- 1000 mg PO q12h
500-1000mg PO q8h
Intermittent Dialysis
250-500mg po q12-24h
Take after dialysis on HD days