Consensus guidelines for oral dosing of primarily renally cleared medications in older adults.
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.
Hanlon
Joseph T
JT
Department of Medicine, University of Pittsburgh, Pennsylvania 15213, USA. jth14@pitt.edu
Aspinall
Sherrie L
SL
Semla
Todd P
TP
Weisbord
Steven D
SD
Fried
Linda F
LF
Good
C Bernie
CB
Fine
Michael J
MJ
Stone
Roslyn A
RA
Pugh
Mary Jo V
MJ
Rossi
Michelle I
MI
Handler
Steven M
SM
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*
D004364:Pharmaceutical Preparations