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Table 1 Drug-lab interaction guidelines for a sample of our selected high-volume medications

From: Translation of evidence into kidney transplant clinical practice: managing drug-lab interactions by a context-aware clinical decision support system

  Medication a ATC category and name b Dose adjustment in renal impairment Dose adjustment in hepatic impairment Pregnancy considerations Lab monitoring considerations
1 Allopurinol M04: ANTIGOUT PREPARATIONS • 10 ≤ CrCl < 20 ml/min/1.73m2: prescribe 200 mg/day per oral
• 3 ≤ CrCl < 10 ml/min/1.73m2: prescribe 100 mg/day per oral
• CrCl < 3 ml/min/1.73m2: prescribe 100 mg per oral every 24 h or longer; or 100 mg per oral every third day.
Dosage adjustment may be necessary; No specific recommendations available Monitor Uric acid level:
• If normal, check it every 6 months.
• If abnormal, change Allopurinol dose accordingly
2 Azathioprine L04: IMMUNOSUPPRESSANTS • If renal impairment or oliguria exists, then dosage should be modified depending on clinical response and degree of renal impairment. No quantitative recommendations are available. Specific guidelines for dosage adjustments in hepatic impairment are not available Discontinue
3 Captopril C09: AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM • 10 ≤ CrCl < 50 ml/min/1.73 m2: reduce the recommended dose by 25%.
• CrCl < 10 ml/min/1.73 m2: reduce the recommended dose by 50%.
No adjustment is required Discontinue Monitor Na and K at the baseline and 1–2 weeks after the start.
4 Cyclosporine L04: IMMUNOSUPPRESSANTS No adjustment is required • In hepatic impairment (ALT > 40 U/mL OR AST > 40 U/L OR Bili-total > 1.5 mg/dl): monitor Cyclosporine blood concentration level. May require dose reduction based on concentration. Monitor Uric acid, K, and Mg levels every 2 weeks in the first 3 months then monthly
5 Hydrochlorothiazide C03: DIURETICS • CrCl < 30 ml/min/1.73 m2: do not use. • In hepatic impairment (ALT > 40 U/mL OR AST > 40 U/L OR Bili-total > 1.5 mg/dl): use with caution, since minor alteration of fluid and electrolyte balance may precipitate hepatic coma. Monitor K, Na and Cl
6 Losartan C09: AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM • CrCl < 30 ml /min/1.73m2: If the patient is also volume-depleted, dose adjustment will be needed. • In hepatic impairment (ALT > 40 U/mL OR AST > 40 U/L OR Bili-total > 1.5 mg/d): initiate with 25 mg per oral once daily. Discontinue Monitor Na and K at the baseline and 1–2 weeks after the start
7 Mycophenolat (mycophenolic acid) L04: IMMUNOSUPPRESSANTS • CrCl < 25 ml/min/1.73 m2: do not exceed 1 g per oral twice daily. No adjustment is required Discontinue Monitor pregnancy test
8 Omeprazole A02: DRUGS FOR ACID RELATED DISORDERS No adjustment is required • In severe hepatic disease (AST > 120 U/L OR ALT > 120 U/ml OR Bili-total > 3 mg/d) and cirrhotic liver disease: reduce Omeprazole dose to 10 mg once daily receiving for long-term therapy. Monitor Mg and Vit B12 levels periodically
  1. Abbreviations: ATC-code Anatomical Therapeutic Chemical-code, CrCl Creatinine clearance, AST Aspartate aminotransferase, ALT Alanine aminotransferase, Bili Bilirubin, Mg Magnesium, P Phosphorus, K Potassium
  2. aMedications are ordered alphabetically
  3. bDrug categories are according to the WHO’s ATC standard