Antiretroviral Dosing Recommendations for Patients with Renal or Hepatic Dysfunction

Generic (Trade)Names Daily DoseDosing in Renal InsufficiencyDosing in
HepaticImpairment
 Nucleoside Reverse Transcriptase Inhibitors
Abacavir* (Abec) 300 mg PO BID No need for dosage adjustment No dosage recommendation
Didanosine (Dinor) > 60 kg 400 mg PO qd< 60 kg 250mg qd
Dose/day
CrCl (mL/min) >60 kg <60 kg
30-59 200mg 125mg
10-29 125mg 100mg
< 10 125mg 75mg
CAPD or hemodialysis patients: use same dose as CrCl < 10 mL/min
No dosage recommendation
Emtricitabine 200 mg PO qd
CrCl (mL/min) Dose
30-4900mg q48h
15-29200mg q72h
<15200mg q96h
Hemodialysis patients: 200 mg q96h (dose after dialysis if dose is due on dialysis day)
No dosage recommendation
Lamivudine* (Lavir) 300 mg PO qd or 150mg PO BID
CrCl (mL/min) Dose
30-49 150mg qd
15-29 150mg x1, then 100mg qd
5-14 150mg x1, then 50mg qd
<5 150mg x1, then 25mg qd
No data on hemodialysis
No dosage recommendation
Stavudine (Stadine) > 60 kg40 mg PO BID< 60 kg30 mg PO BID
Dose/day CrCl (mL/min) >60 kg <60 kg
26-5020mg q12h 15mg q12h
10-2520mg q24h 15mg q24h
Hemodialysis – same dose as CrCl 10-25 mL/min, dose after dialysis on day of dialysis
No dosage recommendation
Tenofovir 300 mg PO qd
CrCl (mL/min) Dose
> 50 300mg qd
30-49 300mg q48h
10-29 300mg biw
ESRD 300mg q wk
No dosage recommendation
Zalcitabine 0.75 mg PO TID
CrCl (mL/min) Dose
10-40 0.75mg BID
< 10 0.75mg qd
No data on hemodialysis
No dosage recommendation
Zidovudine* (Zidine) 300 mg PO BID “Severe” renal impairment or hemodialysis – 100mg TID No dosage recommendation
 Non- Nucleoside Reverse Transcriptase Inhibitors
Delavirdine 400 mg PO TID No dosage adjustment necessary No recommendation; use with caution in patients with hepatic impairment
Efavirenz (Efcure) 600 mg PO qd No dosage adjustment necessary No recommendation; use with caution in patients with hepatic impairment
Nevirapine (Nevir) 200 mg PO BID No dosage adjustment necessary No data available; avoid use in patients with moderate to severe hepatic impairment
Protease Inhibitors
Amprenavir 1,200 mg PO BID No dosage adjustment necessary
Child-Pugh Score Dose
5-8 450mg BID
9-12 300mg BID
Atazanavir 400 mg PO qd No dosage adjustment necessary
Child-Pugh ScoreDose
Class B 300mg qd
Class C not recommended
Fosamprenavir 1,400 mg PO BID No dosage adjustment necessary
Child-Pugh Score Dose
5-8 700 mg BID
9-12 not recommended
Ritonavir boosting should not be used in patients with hepatic impairment
Indinavir (Inbec) 800 mg PO q8h No dosage adjustment necessary Mild to moderate hepatic insufficiency due to cirrhosis;600mg q8h
Lopinavir/ritonavir 400mg/100mg PO BID No dosage adjustment necessary No dosage recommendation; use with caution in patients with hepatic impairment
Nelfinavir 1,250 mg PO BID No dosage adjustment necessary No dosage recommendation; use with caution in patients with hepatic impairment
Ritonavir 600 mg PO BID No dosage adjustment necessary No dosage adjustment in mild hepatic impairment; no data for moderate to severe impairment, use with caution
Saquinavir soft gel cap 1,200 mg TID No dosage adjustment necessary No dosage recommendation; use with caution in patients with hepatic impairment
 Fusion Inhibitors
Enfuvirtide90 mg SQ q12hNo dosage adjustment necessaryNo dosage recommendation

# Combination products of Emtri, Lazid-N, Emduo and Lazdi should not be used in patients with renal insufficiency

Creatinine Clearance
calculation:
Male: (140-age in yr) x weight (kg)
...........................
72 x S.Cr.
Female: (140-age in yr) x weight (kg) x 0.85
...........................
72 x S.Cr.