Computerized drug dosing in renal failure: a real problem and a practical solution.
In the presence of impaired renal function a number of pharmacologic agents require dose adjustments to avoid toxicity. Physician dose variations of a wide range of pharmaceuticals, 237 orders for 30 drugs for 107 patients, were compared to doses recommended by a computer program which considers renal function in calculating its dose. Disagreement in dose regimens was evaluated by comparison of physician-dose to computer-dose for three classes of drugs: wide range, narrow range, and 80% renally excreted. With true renal impairment (serum creatinine greater than or equal to 1.2 mg/100 ml and creatinine clearance less than 80 ml/m) significant overdosing occurred for narrow range and 80% renally-excreted agents, 83 and 77% respectively. There is a great potential hazard observed to be avoided. It is recommended that dose adjustments for nephrotoxic or renally-excreted agents be implemented using creatinine clearance (estimated or measured) with, at the very least, manufacturer's recommendations.
D003201:Computers; D003404:Creatinine / Q000097:blood; D006801:Humans; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000097:blood / Q000188:drug therapy*; D008297:Male; D004364:Pharmaceutical Preparations / Q000008:administration & dosage
D004364:Pharmaceutical Preparations; D003404:Creatinine