Doses of histamine-2-receptor antagonists should be reduced in patients with low glomerular filtration rate
Gary R Matzke
Correspondence Virginia Commonwealth University, Schools of Pharmacy and Medicine, 410 N 12th Street, Suite 454C, PO Box 980533, Richmond, VA 23298-0533, USA
Email gmatzke@vcu.edu
This article has no abstract so we have provided the first paragraph of the full text.
In this insightful paper, Manlucu et al. have conducted a systematic review of the pharmacokinetics and pharmacodynamics of H2RAs in patients with chronic kidney disease (CKD). The data included in this review form the evidence base for the dosage recommendations given in the approved labeling of these agents in most countries. The premise for the review was that clinicians might perceive the quality of the evidence supporting dose adjustment for H2RAs in patients with impaired renal function to be poor, and thus they could be skeptical about the value of dose reduction. All the investigations cited by the authors have clearly shown that H2RAs are predominantly excreted by the kidney, unchanged. Furthermore, the data show that systemic exposure (i.e. AUC) for a given dose of such agents is increased dramatically in individuals with moderate to severe CKD,1 unless the dosage or dosage interval (or both) are altered.
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