In patients with chronic kidney disease, over-the-counter and herbal medicine

use should be assessed to ensure that medications are indicated; medications

with toxic metabolites should be avoided, the least nephrotoxic agents should be
used, and alternative medications should be used if potential drug interactions
exist
Physicians should be aware of drugs with active metabolites that can exaggerate
pharmacologic effects in patients with renal impairment.
Dosages of drugs cleared renally should be adjusted based on the patient's renal
function (calculated as creatinine clearance or glomerular filtration rate); initial
dosages should be determined using published guidelines and adjusted based on
patient response; serum drug concentrations should be used to monitor
effectiveness and toxicity when appropriate.
Pada pasien dengan penyakit ginjal kronik, penggunaan obat bebas dan obat
herbal harus dinilai untuk memastikan bahwa obat sesuai dengan indikasi
kondisi pasien. Obat obat dengan metabolit beracun harus dihindari,
pengobatan dengan obat obat yang bersifat nefrotoksik dan pengobatan
alternatif harus digunakan jika memang potensial obat tersebut ada.
Dokter harus mewaspadai penggunaan obat dengan metabolit aktif