dofetilide and renal function

[Dred Pirate]

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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

 

[El Trombopag]

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.

 

[Dred Pirate]

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.

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

 

[awval999]

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.

 

[Dred Pirate]

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.

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.

 

[El Trombopag]

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.