Trifluridine/tipiracil (LONSURF)

For CrCl 15 to 29 mL/min, use 20 mg/m2 orally twice daily with food on days 1-5 and 8-12 of a 28-day cycle. If not tolerated, reduce to 15 mg/m2 twice daily; discontinue permanently if that dose is not tolerated. Use the label Table 2 for body-surface-area bands and tablet selection; this tool does not calculate or guess rounded tablet doses. No renal adjustment is recommended for CrCl 30 to 89. End-stage renal disease has not been studied.

This RX List version recommends no starting-dose adjustment for CrCl 30 to 89 mL/min. It reports that severe renal impairment below 30 mL/min and end-stage renal disease had not been studied. That older evidence gap must not be interpreted as a current recommendation to use an unchanged dose in severe impairment.

At Cockcroft-Gault CrCl 15-29 mL/min, use 20 mg/m2 based on trifluridine, twice daily with food on Days 1-5 and 8-12 of each 28-day cycle. If not tolerated, the renal-specific reduction is 15 mg/m2 twice daily; discontinue if that is not tolerated. The published tablet table includes unequal morning/evening dosing for a 50-mg daily total: 20 mg in the morning and 30 mg in the evening, not an impossible 25-mg tablet dose. Use the full BSA table for tablet selection. ESRD pharmacokinetics are unstudied.