Page 238 - HIV/AIDS Guidelines

Appendix B, Table 7. Antiretroviral Dosing Recommendations in Patients with Renal or Hepatic
Insufficiency (Last updated March 27, 2012; last reviewed March 27, 2012) (page 1 of 4)

See reference section following tables for creatinine clearance (CrCl) calculation formulas and criteria for Child-Pugh classification.

Antiretrovirals Usual Daily Dose
Generic Name (Refer to Appendix B, Tables Dosing in Renal Insufficiency
(abbreviation)/ 1–6 for additional dosing (Including with chronic ambulatory Dosing in Hepatic Impairment
Trade Name information.) peritoneal dialysis and hemodialysis)
Nucleoside Reverse Transcriptase Inhibitors
Use of fixed-dose combination NRTI (+/- NNRTI) of Atripla, Combivir, Complera, Trizivir, or Epzicom is not recommended in patients with CrCl
<50 mL/min. Use of Truvada is not recommended in patients with CrCl <30 mL/min.
Abacavir 300 mg PO BID No dosage adjustment necessary Child-Pugh
(ABC)/ Score Dose
Ziagen 5–6 200 mg BID
(use oral
solution)
>6 Contraindicated
Didanosine EC Body weight ≥60 kg: Dose (once daily) No dosage adjustment necessary
(ddI)/ 400 mg PO once daily CrCl (mL/min) ≥60 kg <60 kg
Videx EC 30–59 200 mg 125 mg
Body weight <60 kg: 10–29 125 mg 125 mg
250 mg PO once daily <10, HD, CAPD 125 mg use oral
solution
Didanosine oral Body weight ≥60 kg: Dose (once daily) No dosage adjustment necessary
solution 200 mg PO BID or CrCl (mL/min) ≥60 kg <60 kg
(ddI)/ 400 mg PO once daily 30–59 200 mg 150 mg
Videx 10–29 150 mg 100 mg
Body weight <60 kg: <10, HD, CAPD 100 mg 75 mg
250 mg PO once daily or
125 mg PO BID
Emtricitabine 200-mg oral capsule once daily; Dose No dosage recommendation
(FTC)/ CrCl
Emtriva or (mL/min) Capsule Solution
30–49 200 mg q48h 120 mg q24h
240-mg (24-mL) oral solution once 15–29 200 mg q72h 80 mg q24h
daily
<15 or HD 200 mg q96h 60 mg q24h
On dialysis days, take dose after HD session.
Lamivudine 300 mg PO once daily; or CrCl No dosage adjustment necessary
(3TC)/ 150 mg PO BID (mL/min) Dose
Epivir 30–49 150 mg q24h
15–29 1 x 150 mg, then 100 mg q24h
5–14 1 x 150 mg, then 50 mg q24h
<5 or HD 1 x 50 mg, then 25 mg q24h
On dialysis days, take dose after HD session.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents O-13

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