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.
250-500mg PO BID
500mg PO BID
750 - 1500 mg IV q12-24h
750 - 1500 mg IV q8-12h
750 - 1500 mg IV q8h
750-1500mg IV q24h, give dose after HD on dialysis days
500-750mg PO BID after HD, give dose after HD on dialysis days
750-1500mg IV q8h
750-1500 mg IV q24h
250-500 mg PO BID