Pregnancy and renal failure: The case for application of dosage guidelines

Pregnancies in women with renal disease, undergoing dialysis treatment or with kidney transplants are increasingly observed. Serious problems with drug dose adjustment may arise in pregnant women with renal impairment. This review gives a practical overview on the risks of drug use during gestation,...

Full description

Saved in:
Bibliographic Details
Published in:Drugs (New York, N.Y.) N.Y.), 2001, Vol.61 (13), p.1901-1920
Main Authors: KELLER, Frieder, GRIESSHAMMER, Martin, HÄUSSLER, Ulla, PAULUS, Wolfgang, SCHWARZ, Anke
Format: Article
Language:English
Subjects:
Biological and medical sciences
Dose-Response Relationship, Drug
Drug toxicity and drugs side effects treatment
Female
Humans
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - therapy
Kidney Transplantation
Medical sciences
Miscellaneous (drug allergy, mutagens, teratogens...)
Pharmaceutical Preparations - administration & dosage
Pharmacology. Drug treatments
Practice Guidelines as Topic
Pregnancy
Pregnancy Complications - therapy
Renal Dialysis
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Pregnancies in women with renal disease, undergoing dialysis treatment or with kidney transplants are increasingly observed. Serious problems with drug dose adjustment may arise in pregnant women with renal impairment. This review gives a practical overview on the risks of drug use during gestation, the recommended drugs of choice (e.g. methyldopa, cyclosporin), and provides some proposals for dosage adjustments in pregnant women with renal impairment. In normal pregnancy, the glomerular filtration rate and plasma volume increase, whereas plasma protein binding and liver function may be impaired. An increase in dosage is needed for cyclosporin and for methadone because of increased hepatic clearance. The dosage of erythropoetin must be increased because of lower potency in pregnant women. Little more is known on the impact of gestation on drug dose, since pharmacokinetic studies are rarely done in pregnant women. The dosages of magnesium, lithium and morphine must be reduced in renal impairment. Dose adjustment to renal function is critical and is essential for anti-infective agents (e.g. ceftazidime, ganciclovir). Basing drug dose on estimated creatinine clearance might be the most practical solution in pregnant women with renal impairment.
ISSN:0012-6667
1179-1950
DOI:10.2165/00003495-200161130-00003