In the setting of rapidly improving or worsening renal function, calculations of CrCl are inaccurate. Dosing should be based on estimated renal function instead.
If improving renal function, actual CrCl is likely higher than calculated CrCl.
If worsening renal function, actual CrCl is likely lower than calculated CrCl.
CrCl ≥30 mL/min
100-400mg PO/IV Q24h
CrCl <30 mL/min
50-200mg PO/IV Q24h
Full dose after HD
400-800mg PO/IV Q24h