| Generic (Trade)Names | Daily Dose | Dosing in Renal Insufficiency | Dosing 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 |
|---|
| 30-49 | 00mg q48h |
| 15-29 | 200mg q72h |
| <15 | 200mg 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 |
|---|
| 26-50 | 20mg q12h | 15mg q12h |
| 10-25 | 20mg 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 Score | Dose |
|---|
| 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 |
| Enfuvirtide | 90 mg SQ q12h | No dosage adjustment necessary | No dosage recommendation
|
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