FÁRMACOS EN INSUFICIENCIA RENAL

La Asociación Australiana de Médicos de Familia (Australian Family Physician) ha publicado una revisión de fármacos a revisar y a utilizar con precaución en pacientes ancianos con insuficiencia renal crónica: Prescribing for older people with chronic renal impairment

Table 1. Medicines that may accumulate and require renal function monitoring*

Analgesics Genitourinary Anticoagulant Endocrine

Codeine Solifenacin# Dabigatran Glibenclamide

Hydromorphone Sildenafil Enoxaparin Glimepiride

Morphine Tadalafil Rivaroxaban Gliptins (saxagliptin, sitagliptin, vildagliptin)

Oxycodone Tolterodine# Metformin

Tramadol Vardenafil

Neurological Psychotropic Cardiovascular Gastrointestinal

Baclofen Acamprosate ACEIs† H2-antagonists

Gabapentin Amisulpride ARBs†

Galantamine Benzodiazepines Atenolol Musculoskeletal

Levetiracetam Bupropion Bisoprolol Allopurinol

Memantine Desvenlafaxine Digoxin Bisphosphonates

Methysergide Duloxetine Fenofibrate Colchicine

Pramipexole Lithium Strontium ranelate

Pregabalin Paliperidone Teriparatide

Topiramate Reboxetine

Varenicline Venlafaxine

* This list does not include antibiotic, antifungal or antiviral medicines, or those medicines predominately used in the hospital setting # Not available on the PBS/RPBS † Use in renal impairment may increase the risk of hyperkalaemia; monitor potassium levels Reproduced with permission Veterans’ MATES Therapeutic Brief 30. Available at www.veteransmates.net.au

Table 2. Medicines associated with renal func- tion decline or nephrotoxicity

ACEIs* ARBs* Bisphosphonates Frusemide# H2-antagonists NSAIDs/COX-2 inhibitors Penicillamine Proton pump inhibitors†

* Use in renal impairment may increase the risk of hyperkalaemia; monitor potassium levels # Higher doses are often required in renal impairment and may cause decline in renal function; monitor electrolytes † Acute interstitial nephritis is a very rare adverse effect of proton-pump inhibitors Reproduced with permission Veterans’ MATES Therapeutic Brief 30. Available at www.veteransmates. net.au