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DialyzeIHD: Dialyzability of During Intermittent

% Dialyzed % Dialyzed % Dialyzed % Dialyzed IHD Dosing; Administration IHD Dosing; Administration IHD Dosing; Administration IHD Dosing; Administration Timing Drug (Type of Drug (Type of Drug (Type of Drug (Type of Timing Around HD Session Timing Around HD Session Around HD Session Dialyzer) Timing Around HD Session Dialyzer) Dialyzer) Dialyzer) 0.25-0.5mg PO Q8H PRN, Insulin Aspart, 0 4mg/kg IV Q24-36H, Not recommended for use, Clonazepam N/A Reduce to 25-50% of normal dose Acarbose N/A Administer anytime during HD Insulin Detemir, Isethionate (N/A) Administer anytime during HD Administer anytime during HD N/A and titrate, Administer anytime Insulin Glargine, 0.1-0.4mg PO Q8-12H, during HD Normal dose and titrate based on 100-150mg PO Q12-24H, <5 Insulin Lispro Acebutolol N/A Clonidine Administer anytime during HD; No target free or corrected total Administer post-HD (Low Flux) Dose post-HD if hypotensive 75-300mg PO Q24H, (Low Flux) phenytoin level, Normal dose based on indication, 0 Administer anytime during HD Acetaminophen N/A 75mg PO Q24H, Irbesartan Administer anytime during HD; Dose Administer anytime during HD Clopidogrel N/A (N/A) Administer anytime during HD post-HD if hypotensive No 15-45mg PO Q24H, Pioglitazone 2.5-5mg/kg IV/PO Q24H, (N/A) Administer anytime during HD 40-60 250-500mg PO Q6H or 1-2g IV Q4- 100mg IV weekly to monthly, Acyclovir Administer post-HD over 60 Cloxacillin N/A Iron Dextran N/A (N/A) 6H, Administer anytime during HD Administer anytime during HD Piperacillin/ 10-65 2.25g-4.5g IV Q12H, minutes Tazobactam (Low Flux) Administer post-HD over 30 minutes Reduce to 50% of normal dose and 100mg IV weekly to monthly, Normal dose based on work, Iron Sucrose N/A Alfacalcidol N/A titrate, Administer post -HD Administer anytime during HD 0 Normal dose based on indication, Administer anytime during HD Codeine N/A (if given on HD, may require (N/A) Administer anytime during HD 0.25-0.5mg PO Q8H PRN, supplemental dose post -HD) Isosorbide Minimal 5-40mg PO Q8H, Alprazolam N/A 10-80mg PO Q24H, Administer anytime during HD Dinitrate (N/A) Administer post-HD Pravastatin N/A 22-36.7 Reduce to 75% of normal dose Administer post-HD 2-5 100mg PO Q7days, Cyclophosphamide (over 3- 4 hrs) based on indication, 0 100-200mg PO Q24H, (Low Flux) Minimal 1-5mg PO Q8-12H, (Low Flux) Administer anytime during HD Administer post-HD over 20-60 min (High Flux) Administer anytime during HD Prazosin (N/A) Administer anytime during HD Dose based on indication and LD 5-7.5mg/kg IV, then MD 5mg/kg <1 AVOID if possible; 10mg PO Q12H, Cyclosporine target serum level, Normal dose based on indication, 18.5-88 IV QHD (Once daily dosing NOT (Low Flux) Ketorolac N/A Amikacin Administer anytime during HD Administer anytime during HD Prednisone N/A (Low Flux) recommended), Administer post- Administer anytime during HD HD (or over last 10 minutes of HD) 68 AVOID use, 100-400mg PO Q12H, Dabigatran <1 80-160mg PO Q12H, (N/A) Not recommended Labetalol Administer anytime during HD; Dose <5 (N/A) Administer anytime during HD; Dose Minimal Normal dose based on indication, (Low Flux) post-HD if hypotensive post-HD if hypotensive (N/A) Administer anytime during HD 100mg PO Q24H, N/A Administer anytime during HD 17 Normal dose based on indication, 2.5-10mg PO Q24H, Minimal 2.5-10mg PO Q24H, 12 (N/A) Administer post-HD Quinapril Administer anytime during HD; Dose (N/A) Administer anytime during HD 6mg/kg IV QHD, (Low Flux) 39-58 post-HD if hypotensive Daptomycin Administer post-HD over 10 30-47 500mg PO Q24H, (High Flux) Normal dose based on blood work, Amoxicillin minutes Lanthanum N/A Yes 200-300mg PO HS or on HD, (Low Flux) Administer post-HD Administer anytime during HD Quinine No (N/A) Administer anytime during HD 0.45mcg/kg/week IV/SC initially, LD 500mg IV/PO, then 250-500mg 0 Normal dose based on indication, Darbepoetin (High & Low 10-21 Administer anytime during HD Levofloxacin IV/PO Q48H, Administer post-HD Minimal 1.25-5mg PO Q24H, (High Flux) Administer anytime during HD Flux) (High Flux) Ramipril over 60 minutes (Low Flux) Administer post-HD 5mg/kg/week IV, 13-27 0 Dose based on indication, Amphotericin B 0 5mg/kg IV Q24H Deferoxamine Administer post-HD or during last 32-37 600mg IV/PO Q12H, Rituximab (Low Flux) Linezolid (N/A) Administer anytime during HD Lipid Complex (High Flux) Administer anytime during HD hour of HD (Low Flux) Administer post-HD over 30 minutes Normal dose based on indication, 5-40mg PO Q24H, N/A 51 2.5-10mg PO Q24-48H, Rosuvastatin N/A 1000mg IV Q12H, Administer anytime during HD Lisinopril Administer anytime during HD 35-40 (Low Flux) Administer post-HD Ampicillin Administer post-HD (Low Flux) AVOID if possible; 25mg PO Q12H, Dose based on blood work, (or last 10 minutes of HD) Diclofenac N/A Reduce to 25-50% of normal dose; Sevelamer N/A Administer anytime during HD Administer anytime during HD Yes titrate based on target serum level, 50-100 81-325mg PO Q24H (varies based (N/A) ASA LD 0.5-0.75mg (if required), then Administer post-HD Minimal 10-40mg PO Q24H, (N/A) on indication), Administer post-HD Digoxin N/A MD 0.0625mg PO QHD, (N/A) Administer anytime during HD Administer anytime during HD 8 0.5-1mg PO Q8H PRN, 75 25mg PO Q24H, 0 Normal dose based on target serum Atenolol (Low Flux) Administer anytime during HD Sirolimus (Low Flux) Administer post-HD 120-360mg PO Q24H (sustained (N/A) level, Administer anytime during HD Minimal 10-80mg PO Q24H, release), Administer anytime 50-100mg PO Q24H, Atorvastatin N/A 0 Ferric <1 125mg IV weekly to monthly, (N/A) during HD; Dose post-HD if Administer anytime during HD; Dose Administer anytime during HD (High Flux) (N/A) Administer anytime during HD hypotensive post-HD if hypotensive Gluconate Reduce to 50% of normal dose 12.5-25mg IV thrice weekly, 45 25-50mg PO/IV/SC Q8H PRN >32 Azathioprine based on indication, Dimenhydrinate N/A 50-70 500-1000mg IV Q24H, Sodium Administer post-HD over 30-60 (N/A) Administer anytime during HD Meropenem (High Flux) Administer post-HD (Low Flux) Administer post-HD over 15 minutes minutes 25-50mg PO/IV/SC Q6H PRN 250-500mg PO or 500mg IV Q24H, N/A Reduce to 50-75% of normal dose 20 40mg PO Q24H, Azithromycin N/A Administer anytime during HD 1-18 Administer anytime during HD and titrate, Administer anytime (low Flux) Administer post-HD (Low Flux) Dose based on indication and during HD LD 1000mg IV, then 500mg IV 1-2g IV Q72-96H, target free valproic acid level, Streptomycin N/A 40 Q12H, 63 AVOID use, Administer post-HD Aztreonam Administer post-HD, if feasible . Methotrexate (Low Flux) Administer post-HD over 20 Divalproex N/A (High Flux) Not recommended minutes For indication, administer Not recommended; 800/160mg Q12H but may require Sulfamethoxazole/ 60 250mg PO Q12-24H, 2-57 (Double Strength ) PO or 2.5- Normal dose based on indication, supplemental dose post-HD. Methyldopa Trimethoprim Basiliximab N/A (N/A) Administer post-HD (N/A) 10mg/kg TMP IV daily, Administer Administer anytime during HD (SMX/TMP) 1-8mg PO Q24H, post-HD over 30-60 min Minimal 2.5-5mg PO Q24H, Doxazosin Administer anytime during HD; Methyl- 5-20 Normal dose based on indication, N/A (Low Flux) Normal dose based target serum level, Bisoprolol Dose post-HD if hypotensive prednisolone (N/A) Administer post-HD N/A Administer post-HD Administer anytime during HD <8 6 100mg IV/PO Q12-24H, Normal dose based on blood work, 5mg PO/IV Q6H, Administer anytime 20-80mg PO Q24H, (High & Low (N/A) Administer anytime during HD 2-51 0 Administer anytime during HD Metoclopramide during HD; (if given on HD, may Telmisartan Administer anytime during HD; Dose Flux) (Low Flux) (N/A) 400mg PO Q12H, require supplemental dose post-HD) post-HD if hypotensive N/A Calcium Normal dose based on blood work, Administer anytime during HD 12.5-200mg Q12H, 15-30mg PO HS PRN, Acetate, As phosphate binder, administer Temazepam N/A N/A 38-57 2.5-10mg PO Q24-48H, Metoprolol N/A Administer anytime during HD; Dose Administer anytime during HD Calcium with meals; As supplementation, Enalapril post-HD if hypotensive (Low Flux) Administer post-HD 1-20mg PO QHS, Carbonate administer post-HD Terazosin N/A No 25-45 500mg IV/PO Q 8-12H, Administer anytime during HD 100units/kg/week IV/SC initially, Normal dose based on blood work Epoetin alfa (High & Low (Low Flux) Administer post-HD over 20 minutes Calcium Administer anytime during HD Not recommended; 125mg PO Q24H, and indication, Flux) N/A Gluconate Likely Yes 100-150mg IV Q24H, Administer anytime during HD Administer anytime during HD; 500mg IV Q24H, N/A Infusion 30 Dose post-HD if feasible Ertapenem Administer post-HD over 30 Administer anytime during HD 250-500mg PO Q24H, (N/A) N/A minutes Administer anytime during HD 4-32mg PO Q24H, 2.5-10mg PO PRN intradialytic 0 Yes Candesartan Administer anytime during HD; 0-7 250-500mg PO Q12H, Midodrine , 0 LD 100mg IV, then 50mg IV Q12H, (High Flux) (N/A) Tigecycline Dose post-HD if hypotensive (Low Flux) Administer anytime during HD Administer at the start of HD (N/A) Administer anytime during HD 40 12.5-50mg PO Q24H, 10mg PO Q24H, Likely 2.5-80mg PO in 1-2 divided doses, LD 2mg/kg IV, then MD 1-1.5mg/kg IV Ezetimibe N/A Minoxidil (High Flux) (N/A) 50 QHD (Once daily dosing NOT Administer post-HD Administer anytime during HD Administer post-HD Tobramycin (Low Flux) recommended), Administer post-HD Normal dose based on indication, AVOID use, Fenofibrate N/A AVOID if possible; Reduce to 50% of (or last 10 minutes of HD) titrate according to target serum Not recommended 23-51 normal dose and titrate, Administer 9 (Low Flux) level; Administer post-HD, if 0.25-2g PO Q24H, start with low dose Normal dose based on pain Morphine (High & Low post -HD (if given on HD, may 28 (High Flux) feasible. For seizure indication, 0 Flux) N/A and titrate, Fentanyl requirement, require supplemental dose post - administer Q12H but may require (High Flux) Administer anytime during HD Administer anytime during HD HD) supplemental dose post-HD. 25-100mg Q12-24H (50% of normal Ferrous Gluconate, 400mg IV/PO Q24H, dose), Administer post-HD 3.125-25mg PO Q12H, Normal dose based on blood work, Moxifloxacin N/A N/A Ferrous , N/A Administer anytime during HD Carvedilol N/A Administer anytime during HD; Administer anytime during HD (if given on HD, may require Ferrous Fumarate supplemental dose post-HD) Dose post-HD if hypotensive Mycophenolate No 1-1.5g PO Q12H, 5mcg/kg SC Q24H, Mofetil (Low Flux) Administer anytime during HD 50-100mg PO Q12H PRN (immediate LD 70mg IV, then MD 35mg IV Filgrastim N/A Administer anytime during HD release tablets ONLY), N/A Q24H, 55 0.25-2mg PO Q12H, Administer post-HD (if given on HD, Administer anytime during HD 100-200mg IV/PO Q24H, Nabilone N/A (High Flux) 40-63 Administer anytime during HD may require supplemental dose post- Administer post-HD (rate: 1-2g IV QHD, (N/A) HD) 27-50 200mg/hr) N/A 40mg PO QHD, Cefazolin Administer post-HD Nadolol (High Flux) (Low Flux) Administer post-HD 0.5-2mg PO Q24H or 2mg QHD (thrice (or last 10 minutes of HD) Readily 37.5mg/kg PO QHD, Minimal Trandolapril weekly), Administer anytime during (Low Flux) Administer post-HD (N/A) 0 200mg PO Q24H, 0.4-2mg IV PRN, HD; Dose post-HD if hypotensive Cefixime N/A (Low Flux) Administer post-HD 40-80mg IV/PO Q8-24H (based on Administer anytime during HD Minimal 0-44 100mg PO Q24H, requirement), Trimethoprim 1-2g IV Q24H, (N/A) No AVOID if possible; 250mg PO Q12H, (N/A) Administer post-HD 39-60 Administer anytime during HD Naproxen Cefotaxime Administer post-HD (Low Flux) Administer anytime during HD (Low Flux) 33-45 500mg PO Q24H, (or last 10 minutes of HD) 100-300mg PO HS, Valacyclovir 35 Administer post-HD (if given on HD, 60-180mg PO Q8H AC, (N/A) Administer post-HD 1-2g IV QHD, N/A Start with low dose and titrate, 13.7 (Low Flux) may require supplemental dose Dose based on indication and target Cefoxitin Administer post-HD Administer anytime during HD (Low Flux) post -HD) free valproic acid level, Administer (or last 10 minutes of HD) 37-57 Valproic Acid post-HD, if feasible. For seizure LD 2mg/kg IV, then MD 1- 250mg PO Q24H and titrate to (High Flux) 1-2g IV QHD, 1.5mg/kg IV QHD (Once daily Minimal indication, administer Q12H but may 41-81 38-60 500mg PO Q8H, Ceftazidime Administer post-HD Gentamicin dosing NOT recommended), (High Flux) require supplemental dose post-HD. (High Flux) (High Flux) Administer anytime during HD (or last 10 minutes of HD) Administer post-HD (or over last 10 80-320mg PO Q24H, minutes of HD) 30-90mg PO Q24H (sustained 0 21-24 1-2g IV Q12-24H, 2 Valsartan Administer anytime during HD; Dose Ceftriaxone release), (N/A) (High Flux) Administer anytime during HD 40-160mg PO Q12H, (Low Flux) post HD if hypotensive N/A Start with low dose and titrate, Administer anytime during HD 750-1500mg IV Q24H, LD 25mg/kg, then MD IV QHD, Cefuroxime 18-25 Administer anytime during HD Administer post-HD Normal dose based on indication, Administer post-HD or during the last Sodium (Low Flux) 0.25-2mg IV/IM once, based on N/A varies with dosage form, Administer (or last 10 minutes of HD) No part of HD Glucagon indication, post–HD, if feasible MD for patient 80kg or less: 500mg IV AVOID if possible; 100mg PO Q24H, (N/A) 23-38 Celecoxib N/A Administer anytime during HD QHD over last 30 min of HD; Administer anytime during HD 8mg PO/IV Q8H PRN, (High Flux) No AVOID use, Ondansetron N/A MD for patient more than 80kg: 750mg Glyburide Administer anytime during HD 51 250-500mg PO Q12H, (N/A) IV QHD over last 60 min of HD; Cephalexin Not recommended (Low Flux) Administer post-HD Treatment: 75mg PO QHD x 5 days; For higher doses, see PDTM for 25-50mg PO Q8-16H, 53-70 Prophylaxis: 30mg PO Q24H on day infusion time N/A Administer anytime during HD; Oseltamivir 4-8g PO Q12-24H, (N/A) 1, then 30mg QHD Cholestyramine N/A Dose post-HD if hypotensive 180-480mg PO Q24H (sustained Administer anytime during HD Administer post-HD Minimal release), 30-180mg PO Q24H, Normal dose based on indication, N/A 1-2 10-30mg PO HS, (Low Flux) Administer anytime during HD; Dose Cinacalcet N/A Administer anytime during HD Oxazepam Administer anytime during HD (Low Flux) Administer anytime during HD post HD if hypotensive 250-750mg PO or 200-400mg IV Reduce to 50% of normal dose and 23-31 N/A B & C 1 tablet PO Q24H Ciprofloxacin Q24H, Administer post-HD Hydromorphone titrate, Reduce to 50% of normal dose, Yes (Low Flux) Administer anytime during HD 33-53 Administer post-HD (if given on HD, (Renavite) Administer post-HD (or last 10 minutes of HD) Oxycodone (Low Flux) may require supplemental dose post 4-17 AVOID if possible; 300mg PO Q8H, 400 units PO Q24H 250-500mg PO Q24H, -HD) N/A N/A (Low Flux) Administer anytime during HD Administer anytime during HD Administer post-HD 250-500mg IV Q12H, 1-4 million units IV Q12-18H, 200mg PO Q12H (IV not 21-90 10 0 150-600mg PO or 600mg IV Q8H, Imipenem/Cilastatin Administer post-HD over 30 Penicillin G N/A Administer post-HD over 30 recommended), Clindamycin (Low Flux) (High Flux) (Low Flux) Administer anytime during HD minutes minutes Administer anytime during HD No Normal dose based on indication, 20 AVOID if possible; 25mg PO Q12H, 300mg PO Q12H, Administer post- No 5-15mg PO HS PRN; Clobazam Indomethacin Penicillin V N/A Zopiclone (Low Flux) Administer anytime during HD (Low Flux) Administer anytime during HD HD (Low Flux) Administer anytime during HD

HD – Hemodialysis, High Flux – Kuf >20mL/hour/mmHg, Low Flux - Kuf <10mL/hour/mmHg, Kuf – Ultrafiltration coefficient (measure of filtration capacity), LD – Loading Dose, MD- Maintenance Dose, N/A – not available Prepared by Polly Kwok, B. Sc. (Pharm); Marianna Leung, PharmD; Fong Huynh, PharmD Acknowledgements: Kevin Chiu, Michael Chan, Gary Peng