1. Dismiss Notice
  2. Download free Tapatalk for iPhone or Tapatalk for Android for your phone and follow the SDN forums with push notifications.
    Dismiss Notice
  3. Hey Texans—join us for a DFW meetup! Click here to learn more.
    Dismiss Notice

dofetilide and renal function

Discussion in 'Pharmacy' started by Dred Pirate, Aug 5, 2015.

  1. Dred Pirate

    2+ Year Member

    Joined:
    Jan 18, 2014
    Messages:
    2,210
    Likes Received:
    1,636
    Status:
    Pharmacist
    At your hospitals do you have a hard stop as far as what CrCl you will allow for a patient starting on full dose dofetilide? Do you go straight by the manufacturers guidelines 20-40 ml/min = 125 mcg, 40-60 = 250, and >60 = 500? What is the MD insists on pushing the dose? Do you let it slide, or do you have a specific policy that outlines what you do? I am not looking for opinions - I can get 50 of those at work, but want to know what specifically your institution has as far as policy and protocol
     
  2. Note: SDN Members do not see this ad.

  3. El Trombopag

    2+ Year Member

    Joined:
    Dec 7, 2013
    Messages:
    115
    Likes Received:
    108
    Status:
    Pharmacist
    Pretty specific dosing guidelines, using CG-actual BW. We'd automatically dose adjust per renal adjustment protocol. If MD still wants to push it, document 'MD aware' and move on. For something like that though, I'd personally call first.
     
  4. Dred Pirate

    2+ Year Member

    Joined:
    Jan 18, 2014
    Messages:
    2,210
    Likes Received:
    1,636
    Status:
    Pharmacist
    you actually have that on an automatic dosing protocol? That surprises me that you can/would change that without calling the MD (agree I would make the phone call) - I just have issues with some MD's really pushing the limits
     
  5. awval999

    awval999 New Member
    Pharmacist 10+ Year Member

    Joined:
    Oct 30, 2005
    Messages:
    1,023
    Likes Received:
    483
    Status:
    Pharmacist
    I mean they are going to do a EKG/QTc after the dose, so unless it's an egregious discrepancy, ie: CrCL=20 and wanting to start at 500mcg, I don't see the big deal. They are in the hospital after all.
     
  6. Dred Pirate

    2+ Year Member

    Joined:
    Jan 18, 2014
    Messages:
    2,210
    Likes Received:
    1,636
    Status:
    Pharmacist
    I have witnessed two torsades induced cardiac arrests so that is my concern. Just because you are in a hospital and code doesn't mean you will be OK - luckily both of these patients did survive.
     
  7. El Trombopag

    2+ Year Member

    Joined:
    Dec 7, 2013
    Messages:
    115
    Likes Received:
    108
    Status:
    Pharmacist
    Our protocol gives us essentially complete authority to adjust dose/frequency/interval of any drug. That said, it does fortunately allow for 'clinical judgment'. Calling when it makes sense to call, etc.
     

Share This Page