A list of medications routinely prescribed in primary care practice that should be used cautiously or avoided in patients with chronic kidney disease (CKD) was compiled in a recently published study in the Annals of Pharmacotherapy.
Study authors sought to develop the list in order to provide guidance to clinicians in primary care. “We used a systematic review of the literature, a modified Delphi panel, and expert consensus workshop to identify an up-to-date, pragmatic list of medications cleared by the kidneys, used routinely in primary care that must be dose-adjusted or avoided in people with CKD to reduce harm,” the authors explained. Medications were first identified by a group of 17 experts using a 3-round modified Delphi panel. Next, the identified medications were reviewed by a consensus workshop consisting of 8 experts that prioritized them in order to develop point-of-care translation materials.
The literature search yielded a total of 69 medications to be considered by the Delphi panel. At the conclusion of the 3 Delphi rounds, a total of 66 medications remained: 63 that required dose adjustment and 16 that should be avoided in ≥1 estimated glomerular filtration rate (eGFR) category. Lastly, the consensus workshop developed a final list of 24 medications routinely used in the primary care setting that should be avoided or dose adjusted based on a patient’s eGFR.
The list included antibiotics (ciprofloxacin, co-trimoxazole, levofloxacin, nitrofurantoin), anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban), anticonvulsants (gabapentin, pregabalin), antivirals (acyclovir, valacyclovir), antidiabetic agents (canagliflozin, dapagliflozin, empagliflozin, glyburide, metformin), and other medications (baclofen, digoxin, colchicine, lithium, spironolactone, fibrates, duloxetine).
In addition, a list of 12 medications that could be considered for dose adjustment or avoidance was compiled. The drugs on this list included solifenacin, tolterodine, famciclovir, oseltamivir, gliclazide, saxagliptin, sitagliptin, bisphosphonates, escitalopram, metoclopramide, rosuvastatin, and venlafaxine.
“The ultimate goal of this work is to reduce harmful medication prescribing in those with CKD through knowledge translation and dissemination strategies among primary care providers,” the authors stated, adding that “a future evaluation of the impact of this list on the frequency of inappropriate prescribing and adverse clinical outcomes will be needed to confirm its utility.”