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.
400mg IV q24h
500mg PO q24h
200-400mg IV q12h
250-500mg PO q12h
400mg IV q8-12h
500-750mg PO q12h
400mg IV or 500mg PO q24h, dose after HD on dialysis days
400mg IV q12h
500 mg po q24h