Page 239 - 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 2 of 4)

Antiretrovirals
Generic Name Usual Daily Dose Dosing in Renal Insufficiency
(abbreviation)/ (Refer to Appendix B, Tables (Including with chronic ambulatory Dosing in Hepatic Impairment
Trade Name 1–6 for additional dosing peritoneal dialysis and hemodialysis)
information.)
Stavudine Body weight ≥60 kg: Dose No dosage recommendation
(d4T)/ 40 mg PO BID
Zerit CrCl (mL/min) ≥60 kg <60 kg
Body weight <60 kg: 26–50 20 mg q12h 15 mg q12h
30 mg PO BID 10–25 or HD 20 mg q24h 15 mg q24h
On dialysis days, take dose after HD session.

Tenofovir 300 mg PO once daily CrCl (mL/min) Dose No dosage adjustment necessary
(TDF)/ 30–49 300 mg q48h
Viread 10–29 300 mg twice weekly
(every 72–96 hr)
<10 not on HD no recommendation
HD 300 mg q7d
On dialysis days, take dose after HD session.

Emtricitabine (FTC) 1 tablet PO once daily CrCl (mL/min) Dose No dosage recommendation
+ 30–49 1 tablet q48h
Tenofovir (TDF)/ <30 or HD not recommended
Truvada

Zidovudine 300 mg PO BID CrCl (mL/min) Dose No dosage recommendation
(AZT, ZDV)/ <15 or HD 100 mg TID or 300 mg
Retrovir once daily
On dialysis days, take dose after HD session.

Non-Nucleoside Reverse Transcriptase Inhibitors
Delavirdine 400 mg PO TID No dosage adjustment necessary No dosage recommendation; use with
(DLV)/ caution in patients with hepatic
Rescriptor impairment.

Efavirenz 600 mg PO once daily at or before No dosage adjustment necessary
(EFV)/ bedtime
Sustiva
No dosage recommendation; use with
Efavirenz (EFV) + 1 tablet PO once daily Not recommended for use in patients with CrCl caution in patients with hepatic
Tenofovir (TDF) + <50 mL/min. Instead use individual drug impairment.
Emtricitabine (FTC) components of the fixed-dose combination and
Atripla adjust TDF and FTC doses according to CrCl level.

Etravirine 200 mg PO BID No dosage adjustment necessary Child-Pugh Class A or B: no dosage
(ETR)/ adjustment
Intelence
Child-Pugh Class C: no dosage
recommendation

Nevirapine 200 mg PO BID or Patients on HD: limited data; no dosage Child-Pugh Class A: no dosage
(NVP)/ 400 mg PO once daily (using recommendation adjustment
Viramune or Viramune XR formulation)
Viramune XR Child-Pugh Class B or C:
contraindicated

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents O-14

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