Table 5.

General strategies to prevent drug-induced nephrotoxicity

• For renally excreted drugs, the dose should be adjusted for the level of renal function. For this purpose, the Cockcroft–Gault equation is the recommended method for estimating creatinine clearance.

• Avoid concomitant use of nephrotoxic drugs or agents.

• Be vigilant about potential drug–drug interactions that can result in toxic drug levels.

• Whenever possible, choose a drug with a safer nephrotoxic potential, especially when there is preexisting kidney disease.

• Optimize volume status by adequate hydration.

• Use specific prophylactic agents/strategies in appropriate circumstances, eg, alkalinization of urine to prevent methotrexate crystal deposition.

•A multidisciplinary team approach to patient care, which includes the participation of a pharmacist, can substantially improve care by reducing the number of adverse drug reactions.