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J Am Geriatr Soc. 2009 Feb;57(2):335-40. doi: 10.1111/j.1532-5415.2008.02098.x. Epub 2008 Dec 10.

Consensus guidelines for oral dosing of primarily renally cleared medications in older adults.

Author information

1
Department of Medicine, University of Pittsburgh, Pennsylvania 15213, USA. jth14@pitt.edu

Erratum in

  • J Am Geriatr Soc. 2009 Nov;57(11):2179. Dosage error in article text.

Abstract

OBJECTIVES:

To establish consensus oral dosing guidelines for primarily renally cleared medications prescribed for older adults.

DESIGN:

Literature search followed by a two-round modified Delphi survey.

SETTING:

A nationally representative survey of experts in geriatric clinical pharmacy.

PARTICIPANTS:

Eleven geriatric clinical pharmacists.

MEASUREMENTS:

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.

CONCLUSION:

An expert panel of geriatric clinical pharmacists was able to reach consensus agreement on a number of oral medications that are primarily renally cleared.

PMID:
19170784
PMCID:
PMC2640432
DOI:
10.1111/j.1532-5415.2008.02098.x
[Indexed for MEDLINE]
Free PMC Article
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