Consensus guidelines for oral dosing of primarily renally cleared medications in older adults
OBJECTIVES: To establish consensus oral dosing guidelines for primarily renally cleared medications prescribed for older adults.
DESIGN: Literature search followed by a two-round modified Delphi survey.
SETTING: A nationally representative survey of experts in geriatric clinical pharmacy.
PARTICIPANTS: Eleven geriatric clinical pharmacists.
MEASUREMENTS: After a comprehensive literature search and review by an investigative group of six physicians (2 general internal medicine, 2 nephrology, 2 geriatrics), 43 dosing recommendations for 30 medications at various levels of renal function were created. The expert panel rated its agreement with each of these 43 dosing recommendations using a 5-point Likert scale (1=strongly disagree to 5=strongly agree). Recommendation-specific means and 95% confidence intervals were estimated. Consensus was defined as a lower 95% confidence limit of greater than 4.0 for the recommendation-specific mean score.
RESULTS: The response rate was 81.8% (9/11) for the first round. All respondents who completed the first round also completed the second round. The expert panel reached consensus on 26 recommendations involving 18 (60%) medications. For 10 medications (chlorpropamide, colchicine, cotrimoxazole, glyburide, meperidine, nitrofurantoin, probenecid, propoxyphene, spironolactone, and triamterene), the consensus recommendation was not to use the medication in older adults below a specified level of renal function (e.g., creatinine clearance <30 mL/min). For the remaining eight medications (acyclovir, amantadine, ciprofloxacin, gabapentin, memantine, ranitidine, rimantadine, and valacyclovir), specific recommendations for dose reduction or interval extension were made.
CONCLUSION: An expert panel of geriatric clinical pharmacists was able to reach consensus agreement on a number of oral medications that are primarily renally cleared.
| Errataetall: |
ErratumIn: J Am Geriatr Soc. 2009 Nov;57(11):2179 Dosage error in article text |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2009 |
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| Erschienen: |
2009 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:57 |
|---|---|
| Enthalten in: |
Journal of the American Geriatrics Society - 57(2009), 2 vom: 15. Feb., Seite 335-40 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hanlon, Joseph T [VerfasserIn] |
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| Links: |
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| Themen: |
Consensus Development Conference |
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| Anmerkungen: |
Date Completed 02.03.2009 Date Revised 20.10.2021 published: Print-Electronic ErratumIn: J Am Geriatr Soc. 2009 Nov;57(11):2179 Dosage error in article text Citation Status MEDLINE |
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| doi: |
10.1111/j.1532-5415.2008.02098.x |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM186000634 |
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| 100 | 1 | |a Hanlon, Joseph T |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Consensus guidelines for oral dosing of primarily renally cleared medications in older adults |
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| 500 | |a Date Completed 02.03.2009 | ||
| 500 | |a Date Revised 20.10.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ErratumIn: J Am Geriatr Soc. 2009 Nov;57(11):2179 Dosage error in article text | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVES: To establish consensus oral dosing guidelines for primarily renally cleared medications prescribed for older adults | ||
| 520 | |a DESIGN: Literature search followed by a two-round modified Delphi survey | ||
| 520 | |a SETTING: A nationally representative survey of experts in geriatric clinical pharmacy | ||
| 520 | |a PARTICIPANTS: Eleven geriatric clinical pharmacists | ||
| 520 | |a MEASUREMENTS: After a comprehensive literature search and review by an investigative group of six physicians (2 general internal medicine, 2 nephrology, 2 geriatrics), 43 dosing recommendations for 30 medications at various levels of renal function were created. The expert panel rated its agreement with each of these 43 dosing recommendations using a 5-point Likert scale (1=strongly disagree to 5=strongly agree). Recommendation-specific means and 95% confidence intervals were estimated. Consensus was defined as a lower 95% confidence limit of greater than 4.0 for the recommendation-specific mean score | ||
| 520 | |a RESULTS: The response rate was 81.8% (9/11) for the first round. All respondents who completed the first round also completed the second round. The expert panel reached consensus on 26 recommendations involving 18 (60%) medications. For 10 medications (chlorpropamide, colchicine, cotrimoxazole, glyburide, meperidine, nitrofurantoin, probenecid, propoxyphene, spironolactone, and triamterene), the consensus recommendation was not to use the medication in older adults below a specified level of renal function (e.g., creatinine clearance <30 mL/min). For the remaining eight medications (acyclovir, amantadine, ciprofloxacin, gabapentin, memantine, ranitidine, rimantadine, and valacyclovir), specific recommendations for dose reduction or interval extension were made | ||
| 520 | |a CONCLUSION: An expert panel of geriatric clinical pharmacists was able to reach consensus agreement on a number of oral medications that are primarily renally cleared | ||
| 650 | 4 | |a Consensus Development Conference | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
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| 700 | 1 | |a Aspinall, Sherrie L |e verfasserin |4 aut | |
| 700 | 1 | |a Semla, Todd P |e verfasserin |4 aut | |
| 700 | 1 | |a Weisbord, Steven D |e verfasserin |4 aut | |
| 700 | 1 | |a Fried, Linda F |e verfasserin |4 aut | |
| 700 | 1 | |a Good, C Bernie |e verfasserin |4 aut | |
| 700 | 1 | |a Fine, Michael J |e verfasserin |4 aut | |
| 700 | 1 | |a Stone, Roslyn A |e verfasserin |4 aut | |
| 700 | 1 | |a Pugh, Mary Jo V |e verfasserin |4 aut | |
| 700 | 1 | |a Rossi, Michelle I |e verfasserin |4 aut | |
| 700 | 1 | |a Handler, Steven M |e verfasserin |4 aut | |
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