In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.
If worsening renal function, actual GFR is likely lower than calculated.
If improving renal function, actual GFR is likely higher than calculated eGFR.
Not On Dialysis: PO Dosing (EGFR)
No dose adjustment required
500mg PO BID
Not On Dialysis: IV Dosing (EGFR)
750-1500mg IV q12-24h
750-1500mg IV q8-12h
750-1500mg IV q8h
Intermittent Dialysis
IV: 750-1500mg IV q24h, give dose after HD on dialysis days Oral: 500mg PO BID
Continuous Dialysis
750-1500mg IV q12h