Hepatic & Renal dose adjustments of Chemotherapy Drugs
The Drugs which are in bold, details of dose reductions are mentioned below table, scroll down.
GuideLines for Chemotherapy Dosage Adjustment |
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Adjust if Function Impaired | ||
Hepatic | Renal | |
Alemtuzumab | No | No |
Arsenic trioxide | Yes | Yes |
Asparaginase (E coli) | +/- | +/- |
Asparaginase (Erwinia) | +/- | +/- |
Azacitidine | Yes | Yes |
Hepatic | Renal | |
Bendamustine | Yes | Yes |
Bleomycin sulphate | +/- | Yes |
Bortezmib | Yes | +/- |
Brentuximab vedotin | No | No |
Busulfan | +/- | No |
Hepatic | Renal | |
Carboplatin | No | Yes |
Carfilzomib | +/- | No |
Carmustine | +/- | Yes |
Chlorambucil | +/- | Yes |
Cisplatin | No | Yes |
Cladribine | +/- | No |
Clofarabine | +/- | +/- |
Cytarabine | Yes | Yes |
Cytarabine lipid complex | No | No |
Cyclophosphamide | Yes | Yes |
Hepatic | Renal | |
Dacarbazine | +/- | Yes |
Denosumab | +/- | +/- |
Dasatinib | +/- | +/- |
Daunorubicin | Yes | Yes |
Daunorubicin citrate liposomal | Yes | Yes |
Decitabine | +/- | +/- |
Doxorubicin HCl | Yes | No |
Doxorubicin HCl liposomal | Yes | No |
Darbopoetin alpha | No | No |
Hepatic | Renal | |
Etoposide phosphate | Yes | Yes |
Epoetin alpha | No | No |
Filgrastim | No | No |
Fludarabine | +/- | Yes |
Fluorouracil | +/- | +/- |
Hepatic | Renal | |
Gemcitabine HCI | Yes | No |
Gemtuzumab ozogamycin | +/- | No |
Hydroxyurea | +/- | Yes |
lbrutinib | Yes | No |
Idarubicin HCl | Yes | Yes |
Ifosfamide | +/- | No |
Imatinib mesylate | Yes | Yes |
Interferon alf-2b | No | No |
Hepatic | Renal | |
Lenalidomide | No | Yes |
Leucovorin calcium | No | No |
Melphaan | No | Yes |
Mercaptopurine | +/- | Yes |
Mesna | +/- | +/- |
Methotrexate | Yes | Yes |
Mitoxantrone HCl | +/- | No |
Nelarabine | +/- | +/- |
Nilotinib | Yes | No |
Hepatic | Renal | |
Obinutuzumab | +/- | +/- |
Ofatumumab | No | No |
Omacetaxine | +/- | +/- |
Pamidronate | +/- | Yes |
Pegaspargase | No | No |
Plerixafor | No | Yes |
Pomalidomide | +/- | +/- |
Ponatinib HCI | +/- | +/- |
Procarbazine HCI | No | Yes |
Hepatic | Renal | |
Rituximab | No | No |
Thalidomide | No | No |
Thioguanine | +/- | No |
Vinblastine | Yes | No |
Vincristine | Yes | No |
Vincristine Liposomal | +/- | +/- |
Vinorelbine | Yes | No |
Zolendronic Acid | +/- | Yes |
Specific dose reductions are mentioned below.
Arsenic trioxide |
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Azacitidine |
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Asparginase |
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Bendamustine |
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Bleomycin sulfate |
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Bortezomib & Carfilzomib |
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Chlorambucil |
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Cisplatin |
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Cladribine |
The manufacturer recomends repeat courses should not be given until SCr < 1.5 mg/dL and/or BUN <25.
CrCI 10-50 mL/min = Administer 75% of dosage
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Cytarabine |
Cytarabine = 100-200 mg/m2
High dose Cytarabine = 1000-3000 mg/m2
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Cyclophosphamide |
Hepatic Dose
Renal Dose Renal impairment: CrCl <10 mL/min, give 75% of normal dose; CrCl >10 mL/min, give full dose
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Daunorubicin and Daunorubicin citrate Liposomal |
Hepatic Dose
Renal Dose
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Doxorubicin and Doxorubicin HCI liposomal |
Hepatic Dose
Renal Dose = Dose modification not needed.
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Etoposide |
1.5-3.0 mg/dL or SGOT > 180 units = Administer 50% dosage
Decreased albumin increases unbound drug concentration and increases hematologic toxic effects. Renal
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Fludarabine |
Hepatic impairment- Dosage adjustments may be necessary, No specific guidelines are available
Renal Impairment – IV doses
Renal Impairment – Oral Doses
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Gemcitabine |
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Hydroxyurea |
Renal
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Idarubicin |
Hepatic Dose
Renal
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Ifosfamide |
Hepatic
Bilirubin >3 mg/dL = Administer 25% dosage Renal
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Lenalidomide |
Renal
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Melphalan |
Renal
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Mercaptupurine |
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Thioguanine: No hepatic or renal adjustment required |
Methotrexate |
Hepatic Dose
Renal
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Vinblastine |
Hepatic Dose
Renal Dose: No adjustment needed.
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Vincristine |
Hepatic Dose
Renal Dose: No adjustment needed.
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Vinorelbine |
Hepatic Dose
Renal Dose: No adjustment needed.
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