title: Consensus guidelines for oral dosing of primarily renally cleared medications in older adults.
abstract: OBJECTIVE
  To establish consensus oral dosing guidelines for primarily renally cleared medications prescribed for older adults.
  
  
  METHODS
  Literature search followed by a two-round modified Delphi survey.
  
  
  METHODS
  A nationally representative survey of experts in geriatric clinical pharmacy.
  
  
  METHODS
  Eleven geriatric clinical pharmacists.
  
  
  METHODS
  After a comprehensive literature search and review by an investigative group of six physicians (2 general internal medicine, 2 nephrology, 2 geriatrics), 43 dosing recommendations for 30 medications at various levels of renal function were created. The expert panel rated its agreement with each of these 43 dosing recommendations using a 5-point Likert scale (1=strongly disagree to 5=strongly agree). Recommendation-specific means and 95% confidence intervals were estimated. Consensus was defined as a lower 95% confidence limit of greater than 4.0 for the recommendation-specific mean score.
  
  
  RESULTS
  The response rate was 81.8% (9/11) for the first round. All respondents who completed the first round also completed the second round. The expert panel reached consensus on 26 recommendations involving 18 (60%) medications. For 10 medications (chlorpropamide, colchicine, cotrimoxazole, glyburide, meperidine, nitrofurantoin, probenecid, propoxyphene, spironolactone, and triamterene), the consensus recommendation was not to use the medication in older adults below a specified level of renal function (e.g., creatinine clearance <30 mL/min). For the remaining eight medications (acyclovir, amantadine, ciprofloxacin, gabapentin, memantine, ranitidine, rimantadine, and valacyclovir), specific recommendations for dose reduction or interval extension were made.
  
  
  CONCLUSIONS
  An expert panel of geriatric clinical pharmacists was able to reach consensus agreement on a number of oral medications that are primarily renally cleared.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pennsylvania 15213, USA. jth14@pitt.edu
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hanlon
authors.forename: Sherrie L
authors.initials: SL
authors.lastname: Aspinall
authors.forename: Todd P
authors.initials: TP
authors.lastname: Semla
authors.forename: Steven D
authors.initials: SD
authors.lastname: Weisbord
authors.forename: Linda F
authors.initials: LF
authors.lastname: Fried
authors.forename: C Bernie
authors.initials: CB
authors.lastname: Good
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Roslyn A
authors.initials: RA
authors.lastname: Stone
authors.forename: Mary Jo V
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Michelle I
authors.initials: MI
authors.lastname: Rossi
authors.forename: Steven M
authors.initials: SM
authors.lastname: Handler
mesh_terms: D000284:Administration, Oral; D000368:Aged / Q000502:physiology*; D000369:Aged, 80 and over; D003697:Delphi Technique; D006801:Humans; D007668:Kidney / Q000502:physiology*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*
chemical_list: D004364:Pharmaceutical Preparations