institutional regimen difference
Nondialysis percentage differs below CrCl 10
The RX table retains 50% of the indication dose at CrCl <=50 without dialysis. UCSF separates CrCl <10 and uses 25%. Its continuous-dialysis guidance is specifically qualified by CVVHD evidence.
What to reconcileSelect one applicable complete regimen. Do not combine a label percentage with a different institutional dialysis interval.
2 source identities and dates
GlobalRPh RX List - DIFLUCANGlobalRPh-hosted RX List | Source revision: Source revision date not established in selected retrieval.
Selected DIFLUCAN renal section; multidose adjustment is separate from single-dose vaginal-candidiasis treatment.
Read this stored source UCSF fluconazole - adult institutional renal schedulesUCSF Infectious Diseases Management Program | Source revision: Source revision date not established in selected retrieval.
Adult UCSF systemic/oropharyngeal/esophageal/prophylaxis schedules; indication-specific targets required.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v4.1.
threshold ambiguity
Qualitative label versus institutional intervals; exactly 20 overlaps
ANCOBON emphasizes concentration-guided adjustment without a renal interval table. UCSF supplies intervals, but its printed 20-40 and 10-20 bands both include 20.
What to reconcileClarify the boundary and dosing weight with ID/pharmacy; retain serum-level and toxicity monitoring.
2 source identities and dates
GlobalRPh RX List - ANCOBONGlobalRPh-hosted RX List | Source revision: Source revision date not established in selected retrieval.
Oral flucytosine; renal-toxicity and concentration-monitoring section.
Read this stored source UCSF flucytosine - adult institutional renal schedulesUCSF Infectious Diseases Management Program | Source revision: Source revision date not established in selected retrieval.
Adult oral flucytosine institutional schedule; concentration and toxicity monitoring remain necessary.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v4.1.
formulation and era difference
IV avoidance versus historical oral dose reduction below 30
The retrieved IV source advises against treatment below its indexed 30 threshold. Historical OFORTA text instead supplies an oral reduction. Both sources print CrCl with indexed units.
What to reconcileConfirm route, current manufacturer and renal measurement before using either source; do not transfer historical oral instructions to IV dosing.
1 source identities and dates
GlobalRPh RX List - Fludarabine phosphate injectionGlobalRPh-hosted RX List | Source revision: Source revision date not established in selected retrieval.
Intravenous fludarabine source; not oral OFORTA. Regimen-specific oncology review required.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v4.1.
indication scope difference
Labeled single-dose cystitis versus repeated institutional dosing
MONUROL labeling is limited to uncomplicated cystitis. UCSF separately supplies repeated oral doses for complicated cystitis and leaves CrCl exactly 50 unassigned between >50 and <50.
What to reconcileDocument the institutional/off-label rationale and exact renal band. Do not use these oral schedules for pyelonephritis or IV CONTEPO.
2 source identities and dates
GlobalRPh RX List - MONUROLGlobalRPh-hosted RX List | Source revision: Source revision date not established in selected retrieval.
Oral fosfomycin for labeled uncomplicated cystitis in women; not IV fosfomycin.
Read this stored source UCSF oral fosfomycin - cystitis schedulesUCSF Infectious Diseases Management Program | Source revision: Source revision date not established in selected retrieval.
Adult oral fosfomycin; complicated-cystitis repeated dosing is an institutional off-label use relative to MONUROL labeling.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v4.1.
evidence gap
IV loading/maintenance table does not fill every renal setting
CONTEPO supplies integer CrCl bands from 11 through 50 and post-HD timing, but the table does not provide a <=10 or CRRT maintenance regimen.
What to reconcileDo not interpolate uncovered thresholds or derive a regimen from dialysis-removal percentages. Keep the sodium load and renal reassessment visible.
1 source identities and dates
Fosfomycin disodium IV (CONTEPO)DailyMed / Meitheal Pharmaceuticals Inc. | Source revision: Prescribing information 10/2025; SPL effective 2025-11-04
CONTEPO IV for adults >=18 with susceptible-organism cUTI including acute pyelonephritis; not oral fosfomycin.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v4.1.
source quality
CONTEPO: a returned page can still omit the renal dosing table
The new RX card contains selected safety and pharmacokinetic information only. Its retrieved rendering lacked the dosing table; the prior official card is retained separately.
What to reconcileDo not use the limited RX card as a substitute dose table or confuse intravenous CONTEPO with oral fosfomycin.
1 source identities and dates
GlobalRPh RX List - CONTEPOGlobalRPh-hosted RX List | Source revision: Source revision date not established in selected retrieval.
CONTEPO intravenous fosfomycin; not oral fosfomycin tromethamine. The returned RX rendering omits its dosing table.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v4.4.
treatment phase difference
Usual maintenance dosing versus a lower HF starting dose
The broad renal PK statement permits usual dosing, while the HF section prefers 5 mg initially in moderate/severe renal failure or after vigorous diuresis.
What to reconcileMatch initiation versus maintenance and volume/blood-pressure status. No routine maintenance reduction does not mean no monitoring.
1 source identities and dates
GlobalRPh RX List - MONOPRILGlobalRPh-hosted RX List | Source revision: Source revision date not established in selected retrieval.
Adult hypertension or heart-failure treatment; distinguish maintenance PK guidance from initiation sensitivity.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v4.1.
monitoring scope
Fosphenytoin: monitor unbound phenytoin in renal disease
A change in protein binding can make total concentration alone misleading. This renal-monitoring summary does not supply an automatic percentage dose reduction.
What to reconcileConfirm the product-specific population and administration instructions; use the selected unbound-monitoring advice.
1 source identities and dates
GlobalRPh RX List - CEREBYXGlobalRPh-hosted RX List | Source revision: Source revision date not established in selected retrieval.
CEREBYX parenteral fosphenytoin product. Age, indication and administration rates must remain product-specific.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v4.4.
monitoring scope
Fosphenytoin: monitor unbound phenytoin in renal disease
A change in protein binding can make total concentration alone misleading. This renal-monitoring summary does not supply an automatic percentage dose reduction.
What to reconcileConfirm the product-specific population and administration instructions; use the selected unbound-monitoring advice.
1 source identities and dates
GlobalRPh RX List - SESQUIENTGlobalRPh-hosted RX List | Source revision: Source revision date not established in selected retrieval.
SESQUIENT parenteral fosphenytoin product. Age, indication and administration rates must remain product-specific.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v4.4.
formulation
Gabapentin formulations have different renal rules
Immediate-release gabapentin, GRALISE and HORIZANT are not interchangeable renal protocols. HORIZANT also has indication-specific schedules.
What to reconcileSelect the actual formulation and indication before using a dose or dialysis instruction.
1 source identities and dates
GlobalRPh RX List - GraliseGlobalRPh-hosted RX List | Source revision: Revised April 2025
GRALISE only, with evening meal. Not immediate-release gabapentin or HORIZANT.
Read this stored source Source difference identified; final patient-specific adjudication required. Added: vearlier.
ambiguous source boundary
GRALISE: exactly 60 appears in two source rows
The retrieved table prints both >=60 and 30-60, and GRALISE is not interchangeable with immediate-release gabapentin. This is a source-boundary issue, not a reason to average doses.
What to reconcileReconcile the exact value with the current product label and pharmacist review. Do not automatically assign a row or import another formulation's dialysis guidance.
1 source identities and dates
GlobalRPh RX List - Gralise (gabapentin tablets)GlobalRPh-hosted RX List | Source revision: Source revision date not established in selected retrieval.
GRALISE gastroretentive tablets for adult postherpetic neuralgia; not interchangeable with other gabapentin products.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v3.9.
formulation
Gabapentin formulations have different renal rules
Immediate-release gabapentin, GRALISE and HORIZANT are not interchangeable renal protocols. HORIZANT also has indication-specific schedules.
What to reconcileSelect the actual formulation and indication before using a dose or dialysis instruction.
1 source identities and dates
GlobalRPh RX List - HorizantGlobalRPh-hosted RX List | Source revision: Revision date not established in selected retrieval.
Adult HORIZANT; restless legs syndrome (RLS) and postherpetic neuralgia (PHN) have different regimens.
Read this stored source Source difference identified; final patient-specific adjudication required. Added: vearlier.
indication specific dialysis
Dialysis is treated differently in RLS and postherpetic neuralgia
The same HORIZANT renal source discourages use for RLS on hemodialysis but supplies a post-dialysis regimen for PHN. This is an indication difference, not permission to choose the more convenient row.
What to reconcileConfirm indication, extended-release product, titration and discontinuation instructions. Do not substitute immediate-release gabapentin or use the PHN row for RLS.
1 source identities and dates
GlobalRPh RX List - HORIZANTGlobalRPh-hosted RX List | Source revision: April 2025
Adults; oral gabapentin enacarbil extended-release; RLS and PHN kept separate
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v3.8.
source ambiguity
Exact-30 boundary not resolved by RX table wording
The RX table prints greater-than-30 to 59 and greater-than-15 to 29 bands; dialysis supplements are paired to maintenance regimens.
What to reconcileConfirm the exact boundary and matched supplement in the complete current product table; no automatic dose calculation is provided.
1 source identities and dates
GlobalRPh RX List - NeurontinGlobalRPh-hosted RX List | Source revision: Revision date not established in selected retrieval.
Immediate-release gabapentin; source renal table for age 12 years and older.
Read this stored source Source difference identified; final patient-specific adjudication required. Added: vearlier.
formulation
Gabapentin formulations have different renal rules
Immediate-release gabapentin, GRALISE and HORIZANT are not interchangeable renal protocols. HORIZANT also has indication-specific schedules.
What to reconcileSelect the actual formulation and indication before using a dose or dialysis instruction.
1 source identities and dates
GlobalRPh RX List - NeurontinGlobalRPh-hosted RX List | Source revision: Revision date not established in selected retrieval.
Immediate-release gabapentin; source renal table for age 12 years and older.
Read this stored source Source difference identified; final patient-specific adjudication required. Added: vearlier.
ambiguous source boundary
NEURONTIN: printed renal bands leave a boundary unclear
The RX table prints >30 to 59 and >15 to 29; exactly 30 is not clearly assigned. The hemodialysis supplement also belongs with a selected maintenance regimen.
What to reconcileVerify the current table rather than silently rounding into a band. Do not select a supplement without its corresponding maintenance context.
1 source identities and dates
GlobalRPh RX List - Gabapentin (Neurontin)GlobalRPh-hosted RX List | Source revision: Source revision date not established in selected retrieval.
Immediate-release NEURONTIN; renal table for patients at least 12 years old. Not GRALISE or HORIZANT.
Read this stored source Source-specific interpretation; independent clinician adjudication pending. Added: v3.9.