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June 13, 1977

Drug Therapy for Patients in Renal Failure

JAMA. 1977;237(24):2635. doi:10.1001/jama.1977.03270510057027

The prescribing of drugs for patients with compromised renal function presents serious practical problems. The clinician desires to achieve a therapeutic blood level of an agent without exceeding the toxic level. When renal function is normal, the appropriate level of a drug can usually be obtained by administering the dose recommended in the official labeling or in AMA Drug Evaluation.

When the difference between a therapeutic level and a toxic level is small, it may become necessary to measure serum drug levels, and for many drugs, such as the cardiac glycosides and aminophylline, laboratory methods for such measurements are generally available. For many drugs, however, the physician may wish to calculate a dose based on the route of excretion, the normal half-life, and the degree of renal impairment. To assist in such a calculation, The Journal published three articles (214:1468, 1970; 223:991, 1973; 230:1544, 1974) that gave in table outline