Vaginal candidiasis prophylaxis and treatment (four or more episodes yearly): 150mg every 72 hours for three doses followed by 150mg once weekly maintenance dose for six months. Hepatotoxicity (including fatalities) has been observed during treatment but the abnormalities have usually been reversible on discontinuation of fluconazole. Patients who develop abnormal liver tests should be monitored for the development of more serious hepatic injury. Discontinue treatment if clinical signs or symptoms consistent with liver disease develop during treatment. Summary of Product Characteristics: Terbinafine 250 mg tablets. Kent Pharmaceuticals UK Ltd. Revised March 2016. Reversible hyperchloraemic metabolic acidosis, usually with hyperkalaemia, has been reported in patients with decompensated hepatic cirrhosis, even in the presence of normal renal function. Use with caution in patients with a predisposition to metabolic acidosis.

Use with caution in patients with diabetic nephropathy as there is an increased risk of hyperkalaemia. Spironolactone should be discontinued at least 3 days before a glucose tolerance test because of the risk of severe hyperkalaemia in these patients. contains pharmacokinetic data to inform how the medicine will be removed, e.g. amount of parent medicine excreted through the kidneys, how any active metabolites are removed, impact of kidney disease on medication half-life Clinical use: A brief account of the more common indications in renally impaired patients is given. Where an indication or route is unlicensed, this is usually stated.

The ultimate prescribing guide for renal practitioners

Physicochemical Principles of Pharmacy in Manufacture, Formulation and Clinical Use - 6th ed. (2016) Macrocytosis may mask the incidental development of folic acid or vitamin B12 deficiency. Prophylactic supplementation with folic acid is recommended. Hydroxycarbamide may delay plasma iron clearance and reduce the rate of iron utilisation by erythrocytes. It does not appear to alter the red blood cell survival time Tinea unguium (onychomycosis): 150mg once weekly. Treatment should be continued until uninfected nail grows. Usually three to six months for fingernails and six to twelve months for toenails. Animal experiments indicate an increased incidence of congenital defects including the CNS system, palate and skeleton, when hydroxycarbamide is administered during pregnancy. Pharmacokinetics: Basic pharmacokinetic data such as molecular weight, half-life, percentage protein-binding, volume of distribution and percentage excreted unchanged in the urine are quoted, to assist in predicting drug handling in both renal impairment and renal replacement therapy.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London. The information contained within The Renal Drug Database is validated and governed by the UK Renal Pharmacy Group (UKRPG). For further information in the UKRPG, including its aims, events and activities, please visit: www.renalpharmacy.org.uk Quinine is excreted in human breast milk. There is a potential risk of thrombocytopenia in neonates. Therefore quinine should only be used in breastfeeding if the benefits outweighs the risks.Biologics, Biosimilars and Biobetters: An Introduction for Pharmacists, Physicians and other Health Practitioners(2021) Newborns at risk of glucose-6-phosphate dehydrogenase deficiency should not be breastfed until this disease can be ruled out. The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon. The manufacturer does not recommend the use of standard doses or short-term use of fluconazole during pregnancy unless clearly necessary. The manufacturer also recommends that fluconazole should not be used during pregnancy for high or prolonged doses unless in cases of potentially life-threatening infections. The manufacturer recommends a washout period of around 1 week after a single-dose or discontinuation of a course of treatment before becoming pregnant. Advise patients to report any signs or symptoms of unexplained persistent nausea, decreased appetite, fatigue, vomiting, right upper abdominal pain, or jaundice, dark urine or pale faeces. Side Effects

Summary of Product Characteristics: Azocan 200mg capsules. FDC International Ltd. Revised June 2016. Small studies have shown that doses of 25mg spironolactone three times per week can be used safely in haemodialysis patients although it is unknown whether or not this dose would have any therapeutic benefit. Potassium levels should be monitored closely. ContraindicationsMetabolism: Very few drugs are 100% excreted via either the liver or the kidneys. Many are metabolised by the liver to either active or inactive metabolites, and some of these may be excreted via the kidneys. Pharmacologically active metabolites that undergo renal excretion must be taken into account when prescribing the parent drug in patients with renal impairment.

Treatment of fungal infections of the skin and nails caused by Trichophyton (e.g. T. rubrum, T. mentagrophytes, T. verrucosum, T. violaceum), Microsporum canis or Epidermophyton floccosum dermatophytes. Long test: 400mg spironolactone is administered daily for three to four weeks. Correction of hypokalaemia and of hypertension provides presumptive evidence for the diagnosis of primary hyperaldosteronism. High doses of quinine have been used to attempt induction of abortion and may cause congenital abnormalities of the CNS and extremities, and high doses have been associated with deafness and photosensitivity in the neonate. However, standard malaria treatment doses are considered to be safe in pregnancy. The Renal Drug Database is not intended to offer definitive advice or guidance on how drugs should be used in patients with renal impairment, nor is it a comprehensive and complete list of all drugs licensed in the UK. Summary of Product Characteristics: Terbinafine 250 mg tablets. Dr Reddy's laboratory UK Ltd. Revised March 2017.Pharmaceutical Preformulation and Formulation: a Practical Guide from Candidate Drug Selection to Commercial Dosage Form - 2nd ed. (2009) Summary of Product Characteristics: Quinine Sulfate Tablets 300mg. Actavis UK Ltd. Revised April 2013. Antiandrogenic effects have been seen in humans and feminization in male rat foetuses has been observed with spironolactone. In one study, rat offspring of both sexes exposed in utero in late gestation exhibited permanent dose related changes in their reproductive tracts. In animal experiments carcinogenic effects have been seen, although as yet, there are no indications of any clinical relevance of this finding to humans. No reports associating spironolactone to congenital defects (cardiovascular defects, spina bifida, polydactyly, limb reduction defects and hypospadias) in human pregnancies have been found (Briggs, 2011).