Drugs that require dose alteration in CKD

Anti-infectives

AminoglycosidesBeta-lactam antibioticsFluconazoleQuinolones (except moxifloxacin)Vancomycin

Cardiovascular drugs

LMWHs (enoxaparin)RivaroxabanApixabanDabigatran

GI Drugs

H2RAs Famotidine, RanitidineMetoclopramide

Other agents

BisphosphonatesLithium

Contraindicated if CrCl < 60

Nitrofurantoin

Contraindicated if CrCl < 50

Tenofovir DFVoriconazole IV

Contraindicated if CrCl < 30

Tenofovir AFNSAIDsDabigatranRivaroxaban

Contraindicated if GFR < 30

SGLT2 inhibitorsMetformin

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