Archive 1992–2014

Objective. This study is about the dosing of psychiatric drugs in psychiatric patients with chronic kidney disease (CKD). It gives a detailed account of drugs whose dosage must be reduced.
Review. Psychiatric disorders often coexist with renal insufficiency. On the other hand, a number of psychiatric patients are at risk for renal impairment. It is also known that renal dysfunction can alter the metabolism of certain drugs. Inappropriate dosing in patients with chronic kidney disease may lead to intoxication or ineffective therapy. The question therefore arises: which medications can safely be prescribed and which must be administered in reduced doses to psychiatric patients with chronic kidney disease?
Conclusion. Not many studies describe the pharmacokinetics of psychotropic agents in patients with CKD at different stages of renal function impairment because most clinical trials exclude patients with advanced renal insufficiency. The pharmacokinetic properties of a selection of drugs often used in clinical practice are reviewed. The review of the literature suggests that most psychotropic medications are well tolerated in the treatment of patients with renal insufficiency although more clinical trials are needed. This is because most of the drugs are fat soluble and mainly metabolised by the liver and subsequently secreted with the bile.