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Related Concept Videos

Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration

Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area. This equation is...
Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance01:25

Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance

In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance (Clcr), a...
Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
Dosage Regimens: Partial Pharmacokinetic Parameters01:01

Dosage Regimens: Partial Pharmacokinetic Parameters

It is not uncommon for complete drug pharmacokinetic profiles to remain elusive in pharmacokinetics. This necessitates certain educated assumptions by pharmacokineticists to determine appropriate dosage regimens without comprehensive pharmacokinetic data from animal or human studies. One prevalent assumption is setting the bioavailability factor, denoted as F, to 1 or 100%. This assumption caters to the scenario where a drug doesn't achieve full systemic absorption, resulting in the patient...

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Related Experiment Videos

Inappropriate Valacyclovir Dosing by Renal Function in Japan.

Sumire Suzuki1,2, Yuki Kondo1, Kaho Sato1

  • 1Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Japan.

The Journal of Pharmacy Technology : Jpt : Official Publication of the Association of Pharmacy Technicians
|July 9, 2026
PubMed
Summary
This summary is machine-generated.

Valacyclovir overdosing is common in patients with impaired renal function in Japan, especially for high-dose treatments. This occurs more often in women and with prescriptions from community pharmacies, highlighting a need for better dosing reviews.

Keywords:
dose adjustmentmedication safetyreal-world datarenal impairmentvalacyclovir

Related Experiment Videos

Area of Science:

  • Pharmacology
  • Nephrology
  • Public Health

Background:

  • Valacyclovir dosing requires adjustment based on renal function to prevent adverse events.
  • Real-world data on current valacyclovir dosing practices concerning renal function is limited.

Purpose of the Study:

  • To determine the frequency of valacyclovir overdosing in relation to renal function in Japan.
  • To identify patient and prescription characteristics associated with valacyclovir overdosing.

Main Methods:

  • A retrospective cohort study utilized nationwide administrative claims and laboratory data from Japanese acute care hospitals.
  • Adult patients (≥18 years) receiving valacyclovir between October 2022 and September 2024 with recent serum creatinine measurements were included.
  • Overdosing was defined as exceeding the Japanese package insert's maximum recommended dose based on creatinine clearance (Cockcroft-Gault equation).

Main Results:

  • Out of 7901 prescriptions, 1649 (20.9%) were for patients with impaired renal function.
  • Valacyclovir overdosing was infrequent in normal renal function but occurred in 25.1% of prescriptions for varicella/herpes zoster and 6.4% for other indications among those with impaired renal function.
  • Overdosing was more prevalent in women and for prescriptions dispensed at community pharmacies.

Conclusions:

  • Valacyclovir overdosing is a significant issue in Japan for patients with impaired renal function, particularly with high-dose regimens.
  • Factors such as patient sex and dispensing location (community pharmacies) are associated with increased overdosing.
  • Enhanced review of valacyclovir prescriptions based on renal function is crucial to prevent avoidable overdosing.