The development of a drug dosage adjustment service for patients with renal impairment

The dosage of nephrotoxic drugs such as gentamicin should ideally be adjusted when they are administered to patients with varying degrees of renal impairment. Such as adjustment of dosage should be estimated with a knowledge of the plasma levels of the drug. Until regular monitoring of drug levels of plasma is routinely available, the use of nomograms which utilize pharmacokinetic data quoted in the literature would provide dosage regimens tailored to suit the individual need of the renal patients. A service for dosage adjustment of nephrotoxic drugs has been provided in the Macclesfield Health District since December 1977 and has been well received by prescribers in the hospitals. The use of flow chart scheme for the adjustment of individual dosage for routine use is described. About 80% of the requests were for dosage adjustments of gentamicin in renal failure. It is advocated that such a service can be provided by hospital pharmacists without difficulty and should be encouraged as part of the patient services.