Usage and Dosing
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Renal Adjustment
| Half-life bình thường | 6 |
|---|---|
| Half-life ESRD | 200–250 |
| Liều bình thường | 15–20 mg/kg IV q8–12h |
| Chỉnh liều suy thận | CrCl >100: No dosage adjustment CrCl >50–100: 15–20 mg/kg q12h CrCl 20–50: 15–20 mg/kg q24h CrCl <20: 15–20 mg/kg q48h |
| Hemodialysis | POST-HD DOSING Low permeability membrane: Load: 25 mg/kg Maintenance: 7.5 mg/kg AD High permeability membrane: Load: 25 mg/kg Maintenance: 10 mg/kg AD INTRADIALYTIC DOSING Low permeability membrane: Load: 30 mg/kg Maintenance: 7.5–10 mg/kg High permeability membrane: Load: 35 mg/kg Maintenance: 10–15 mg/kg |
| CAPD | 7.5 mg/kg q48–96h |
| CRRT | Load: 20–25 mg/kg Maintenance: 7.5–10 mg/kg q12h (effluent 20–25 mL/kg/hr). TDM suggested. |
| SLED | Load: 20–25 mg/kg Maintenance: 15 mg/kg AD (or during final 60–90 min of dialysis). TDM suggested. |
Hepatic Adjustment
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ECMO Dosing Adjustment
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Intraperitoneal Dosing Adjustment, CAPD
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Obesity Dosing Adjustment
| Recommendation | Use actual BW |
|---|---|
| Comments | Current guidelines: loading dose 20-25 mg/kg (max 3 gm), maintenance dose 15-20 mg/kg (max 2 gm) q8-12h. Daily doses >4.5 gm should rarely be required. Early and frequent AUC24 monitoring is recommended (Am J Health Syst Pharm 2020;77:835). Decreased AKI risk with AUC24 monitoring (compared to trough monitoring) in patients with BMI >30 (Antimicrob Agents Chemother 2022;66:e0088621). Controversy continues: recent review suggests loading dose based on actual BW and maintenance dose based on adjusted BW (Expert Opin Drug Metab Toxicol 2022;18:323). |
Adverse Effects
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Dược lý
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