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eGFR — dose adjustment
Clinical decision-support table for rapid consultation of drug dose adjustment according to estimated glomerular filtration rate (eGFR). It helps identify when the dose should be reduced, the dosing interval extended, or certain medicines avoided according to renal function.
FAQ
Drug dose adjustment in renal impairment — Frequently asked questions (FAQ)
1) What is this table for?
The table allows rapid consultation of the need for drug dose adjustment according to renal function. For each medicine, it may indicate whether it is necessary to reduce the dose, increase the dosing interval, use a lower maximum dose or avoid the medicine below certain levels of renal function. The information should be confirmed in the Summary of Product Characteristics (SmPC) before prescribing.
2) Why is it necessary to adjust the dose of some medicines in renal impairment?
Reduced renal function may decrease the elimination of certain medicines or their metabolites, increasing systemic exposure and the risk of adverse effects or toxicity. Adjustment may involve reducing the administered dose, increasing the interval between doses or, in some cases, using an alternative treatment.
3) Should I use estimated GFR (eGFR) or creatinine clearance?
It depends on the medicine and on the information used to establish its dosing recommendation. Estimated GFR (eGFR) is currently widely used to assess renal function and may be used for dosing many medicines. However, some SmPCs and pharmacokinetic studies use creatinine clearance (CrCl), often calculated using the Cockcroft–Gault formula. Whenever a medicine’s recommendation specifies a particular method, that method should be used.
4) Are eGFR and creatinine clearance equivalent?
Not necessarily. eGFR and creatinine clearance are different estimates of renal function and may produce different values in the same patient, particularly in older people, individuals with very low or high body weight or those with significant changes in muscle mass. For this reason, dose-adjustment thresholds should be interpreted according to the specific source for each medicine.
5) Can the table be used when renal function is changing rapidly?
It should be used with particular caution. Creatinine-based renal function estimation formulas assume relatively stable renal function and may be unreliable in acute kidney injury or rapidly changing creatinine levels. In these situations, dosing decisions should take into account the clinical course, serial renal function measurements, the pharmacokinetic characteristics of the medicine and, when applicable, therapeutic drug monitoring.
6) Is it always necessary to reduce the dose when GFR decreases?
No. The impact of renal impairment depends on the route of elimination, therapeutic index, active metabolites, clinical indication and pharmacokinetic characteristics of each medicine. Some medicines do not require adjustment, others require dose reduction or an increased dosing interval, and some should be avoided below certain levels of renal function.
7) How should I interpret a recommendation to “avoid” or “not recommended”?
It means that, within the indicated range of renal function, the medicine may be associated with increased exposure, risk of toxicity, insufficiently studied efficacy or inadequate safety data. The wording used and its meaning should be confirmed in the SmPC, as “not recommended” is not necessarily equivalent to a formal contraindication.
8) Can the loading dose and maintenance dose require different adjustments?
Yes. For some medicines, particularly when a loading dose is required, this may depend mainly on the volume of distribution and may not require the same reduction as the maintenance dose. Adjustment of the maintenance dose is more commonly related to reduced drug clearance. The specific recommendation in the SmPC or pharmacological source used should be followed.
9) What should be done when renal function is close to a dose-adjustment threshold?
When renal function is close to a dosing threshold, the trend of previous values, stability of renal function, age, body composition, risk of toxicity and the therapeutic index of the medicine should be considered. For higher-risk medicines, it may be necessary to confirm the estimate of renal function or perform closer clinical and laboratory monitoring.
10) Does this table replace the SmPC or the prescribing system?
No. The table is a consultation and clinical decision-support tool. Dosing recommendations may be updated and may vary between medicines, formulations or indications. Before prescribing, the dose should be confirmed in the current SmPC and, where applicable, in the prescribing system and specific clinical recommendations.
06/09/2026
0medicines
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Clinical decision-support tool. Confirm dosing in the current SmPC and use the renal function measure specified for each medicine (eGFR or CrCl, where applicable).
| Medicine | Group | Class | Usual dose | eGFR ≥60 | eGFR 45–59 | eGFR 30–44 | eGFR 15–29 | eGFR <15 / kidney failure | Clinical notes |
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