Table V.

Dose modification of selected symptomatic medications in renal insufficiency [20, 52, 55–59]

Symptomatic medication	Dose modification in renal insufficiency
NSAIDs (general recommendations*)	CrCl ≥ 60 ml/min – NDAR [52] CrCl 30–60 ml/min – caution should be exercised [52] CrCl < 30 ml/min – use should be avoided [52]
	Hemodialysis, peritoneal dialysis, CRTT*
Paracetamol (acetaminophen)	CrCl > 30 ml/min NDAR – 0.5 mg every 6 hours [55] CrCl 10–30 ml/min – 0.5 g every 6 hours [55] CrCl < 10 ml/min – 0.5 g every 8 hours [55]
	Hemodialysis: 0.5 g every 8 hours [20] Peritoneal dialysis: 0.5 g every 8 hours [20] CRTT: 0.5 g every 6 hours [20]
Tramadol	CrCl ≥ 30 ml/min – IR/ER – NDAR [56] CrCl < 30 ml/min – IR – increase dosing interval to every 12 hours (maximum daily dose of 200 mg); ER – should be avoided [56]
	Hemodialysis: IR – lower initial doses and an extended dosing interval. Do not exceed 50 mg twice daily, a uremic state may lower seizure threshold. ER – should be avoided [57–59] Peritoneal dialysis: IR – lower initial doses and an extended dosing interval. Do not exceed 50 mg twice daily, a uremic state may lower seizure threshold. ER – should be avoided [57–59] CRTT: Lower initial doses and an extended dosing interval. Do not exceed 50 mg twice daily, a uremic state may lower seizure threshold. ER – should be avoided [20, 57–59]

CrCl – creatinine clearance CRTT – continuous renal replacement therapy, ER – extended release, IR – immediate release, NDAR – no dose adjustment required, NSAIDs – nonsteroidal anti-inflammatory drugs,

^*– dosage modification recommendations may vary for individual medications within the NSAIDs group.