Enter CrCl to highlight appropriate doses for renally-cleared drugs
Enter Creatinine Clearance
Enter CrCl 1–200
Antibiotics
Drug
Normal Dose
CrCl ≥50
CrCl 30–49
CrCl 15–29
CrCl <15 / HD
Amoxicillin
500mg Q8h
Standard
Standard
Q12h
Q24h
Pip-Tazo
4.5g Q6h
Standard
4.5g Q8h
2.25g Q6h
2.25g Q8h
Ciprofloxacin IV
400mg Q12h
Standard
Standard
200mg Q12h
200mg Q12h
TMP-SMX (DS)
1 DS Q12h
Standard
50% dose
Avoid
Avoid
Acyclovir IV
10mg/kg Q8h
Standard
Q12h
Q24h
5mg/kg Q24h
Cardiovascular / Diabetes
Drug
Normal Dose
CrCl ≥50
CrCl 30–49
CrCl 15–29
CrCl <15 / HD
Metformin
500–2000mg/day
Standard
Use caution
Avoid
Avoid
Digoxin
0.125–0.25mg QD
Standard
0.125mg QD
0.0625–0.125mg QD
0.0625mg Q48h
Allopurinol
300mg QD
Standard
200mg QD
100mg QD
50–100mg QD
Colchicine
Standard
Standard
Reduce 50%
Reduce 50%
Avoid
Neurology / Analgesics
Drug
Normal Dose
CrCl ≥50
CrCl 30–49
CrCl 15–29
CrCl <15 / HD
Gabapentin
300–1200mg TID
Standard
300–600mg BID
300mg QD
100–300mg QD
Note: This table is a general reference. Always verify with current prescribing information, institutional protocols, and clinical pharmacist. CrCl from Cockcroft-Gault is used for drug dosing (not eGFR). HD = hemodialysis. Highlighted column = recommended dose for entered CrCl.
