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CVVH Initial Drug Dosing Guidelines
Provided to the Drug Monitor by
Dr. Bruce Mueller
Updated 5/5/2000
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These initial dosing guidelines are applicable to adult patients with anuric / oliguric acute renal failure, normal hepatic function, and an ultrafiltration rate of 1 Liter / hour. These are recommendations for initial dosing only. Subsequent dosage adjustments should be guided by serum levels and clinical judgement.
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| Drug | Loading Dose | Maintenance Dose |
| Acyclovir | ----- | 5 mg/kg Q12H |
| Amikacin | 7.5 mg/kg | 7.5 mg/kg Q24H |
| Aztreonam: | 2 g | 1 g Q12H |
| Cefepime: | 2 g | 1 g Q12H |
| Cefoperazone | 2 g | 1 g Q12H |
| Ceftazidime | 2 g | 1 g Q12H |
| Cimetidine | ----- | 300 mg Q8H or
900 mg/24H in TPN |
| Ciprofloxacin | ----- | 400 mg Q24H |
Co-trimoxazole
(SMX/TMP)(IV) | ----- | 2.5 mg/kg TMP Q8H |
| Fluconazole | 400 mg | 200 mg Q24H |
| Gent/Tobra | 2 mg/kg | 1.5 - 2 mg/kg Q24H |
| Ganciclovir | ----- | 2 mg/kg Q24H |
| Imipenem | ----- | 500 mg Q8H |
| Metronidazole | 1 g | 500 mg Q8H |
| Piperacillin | ----- | 3 g Q8H |
| Procainamide (IV) | 1 - 2 g | 1 mg/min |
| Ranitidine (IV) | ----- | 150 mg/24H in TPN or
50 mg Q8-12H |
| Vancomycin | 15 mg/kg | 10 mg/kg Q24H |
Vitamins: supplement water soluble vitamins or double MVI
Pressors, analgesics, paralytics, and anxiolytics are titrated to response |
| For a primer on CVVH and other modalities of continuous renal replacement therapy (CRRT) the reader is referred to the 3/98 issue of The Annals of Pharmacotherapy '98; 32:362-374.
References on drug dosing in CRRT:
- Schetz M, Ferdinande P, Van den Berghe G et al. Pharmacokinetics of continuous renal replacement therapy. Intensive Care Med 1995;21:612-620.
- Golper TA, Marx MA. Drug dosing adjustments during continuous renal replacement therapies. Kidney Int 1998;53 suppl 66: S165-168.
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