| Title | Consensus guidelines for oral dosing of primarily renally cleared medications in older adults. | | Author(s) | Hanlon JT, Aspinall SL, Semla TP, Weisbord SD, Fried LF, Good CB, Fine MJ, Stone RA, Pugh MJ, Rossi MI, Handler SM | | Institution | Department of Medicine, University of Pittsburgh, Pennsylvania 15213, USA. jth14@pitt.edu | | Source | J Am Geriatr Soc 2009 Feb; 57(2):335-40. | | MeSH | Administration, Oral
Aged
Aged, 80 and over
Delphi Technique
Humans
Kidney
Pharmaceutical Preparations
| | 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. | | Language | eng | | Pub Type(s) | Consensus Development Conference
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
| | PubMed ID | 19170784 |
|
