Actionable Renal Dosing Content for Nephrotoxic Medications in 4 Drug Information Resources Commonly Used in the United States

Abstract

Introduction: Inclusion of numeric, actionable renal dosing recommendations in drug information resources enhances the safe use of nephrotoxins. Purpose: The purpose of this study was to systematically and descriptively characterize the renal dose recommendations for nephrotoxic medications in 4 common drug information resources. Methods: A list of nephrotoxins (N = 154) was generated from previously published lists. Renal dosing information was collected for each drug from the package insert, Lexi-comp (now called UpToDate Lexidrug), Micromedex, and Clinical Pharmacology. Dosing recommendations were categorized using a previously published 6-category scale based on whether recommendations were included vs missing, and numeric vs non-numeric. Results: Actionable renal impairment recommendations (numeric, non-numeric, contraindicated, no dose adjustment required) in the package insert, Lexi-comp, Micromedex, and Clinical Pharmacology were present for 88.3%, 98.1%, 94.2%, and 98.1% of drugs, respectively. Numeric recommendations were available for 54.5% to 75.3% of medications, depending on the source. Actionable recommendations for hemodialysis, peritoneal dialysis, continuous renal replacement, and hybrid dialysis modalities were more common in Lexi-comp (83.1%, 75.3%, 62.3%, and 53.9% of medications, respectively) vs the other resources. Actionable pediatric renal impairment (76.0%) and older adult (95.5%) recommendations were also more common in Lexi-comp than other resources. Conclusions: Drug information resources included actionable renal dosing recommendations for most known nephrotoxins, with Lexi-comp being most likely to include this information. Numeric and/or actionable recommendations for specific dosing populations (eg, renal replacement modalities, pediatric renal impairment, older adults) were generally lacking. Lack of agreement among resources suggests a need to check multiple sources in practice.