Table 2

Medication-related actions that HCPs made to help address a renal-drug problem (n=21 incidents)

IncidentsMedication-related actions
Decrease doseDecrease frequencyDiscontinueSubstitute
Colchicine1.2 mg, 0.6 mg in an hour → 0.6 mg, may repeat in 2 weeks
Enoxaparin40 mg daily → 30 mg daily
Fenofibrate*145 mg → 48 mg
Gabapentin600 mg tid → 600 mg bid
Gabapentin800 mg bid → 600 mg bid
Gabapentin300 mg tid to 600 mg bid
Levofloxacin†500 mg daily → 250 mg daily
LisinoprilLisinopril temporarily held
Metformin500 mg qid → 500 mg tid
Nitrofurantoin→ Cephalexin
Piperacillin/tazobactam, famotidinePiperacillin/tazobactam: 3.375 g q6h → 2.25 g q6hFamotidine:
20 mg bid → 20 mg daily
Piperacillin/tazobactam→ oral antibiotic
Ranitidine, fenofibratefenofibrateRanitidine → pantoprazole
Tenofovir in combination tablet (efavirenz +  emtricitabine) → abacavir containing combo pill
Valganciclovir900 mg → 450 mgbid → daily
Vancomycin, piperacillin/tazobactamVancomycin: initial dose at 1250 mg q12h, held 1 day, restart at 1250 mg dailypiperacillin/tazobactam
Total=24 drug problems 6 6 8 4
  • Except for one incident involving valganciclovir, HCPs made one medication-related action per renal-drug problem.

  • *co-occurring with concern for fenofibrate-simvastatin drug-drug interaction.

  • †co-occurring with concern for levofloxacin-prednisone drug-drug interaction.

  • bid, two times per day; HCPs, healthcare professionals, HCTZ, hydrochlorothiazide; qid, four times per day; q6h, every 6 hours; q12h, every 12 hours, tid, three times per day.