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
8-20 mg/kg IV divided into Q6-12h
CrCl 10-29 mL/min
4-10 mg/kg IV divided Q6-12h
CrCl <10 mL/min
Do not use
2.5-10 mg/kg IV Q24h, or 5-20 mg/kg IV TIW (doses given on HD days should be given after HD)
2.25-7.5 mg/kg IV Q12h