Psychiatry & Co-Morbid Medical Conditions: Renal (Q.2)


Psychiatry & Co-Morbid Medical Conditions: Renal



This question series will focus on clinically relevant questions related to the role of psychotropic medications in patients with underlying renal disease. 


(Q.1): Which of the following antipsychotic medication will need dosage adjustment in patient with schizophrenia and moderate renal impairment (eCrCl = 31-50 mL/min)?

  1. Paliperidone
  2. Olanzapine
  3. Clozapine
  4. Quetiapine


Answer =>


(Q.2): Which of the following mood stabilizer will NOT need dosage adjustment in patient with eCrCl of 25 mL/min?

  1. Lithium
  2. Depakote
  3. Oxcarbazepine
  4. Gabapentin
  5. Topiramate

Answer: 2. Depakote.


  • A slight reduction (27%) in the unbound clearance of valproate has been reported in patients with renal failure (creatinine clearance < 10 mL/minute); however, hemodialysis typically reduces valproate concentrations by about 20%. Therefore, no dosage adjustment appears to be necessary in patients with renal failure.
  • Protein binding in these patients is substantially reduced; thus, monitoring total concentrations may be misleading.
  • In patients with creatinine clearance <30 mL/min: initiate at one-half the usual starting dose (300 mg/day, given twice-a-day) and increase slowly to achieve the desired clinical response.
  • Creatinine Clearance > 60 : 900 to 3600 mg/day.
  • Creatinine Clearance >30-59: 400- 1400 mg/day.
  • Creatinine Clearance >15-29: 200- 700 mg/day.
  • Creatinine Clearance <15: 100-300 mg/day.
  • In renally impaired patients (creatinine clearance less than 70), one-half of the adult dose is recommended.
  • Mild to moderate renal impairment (CLcr 30 to 89 mL/min): Start with low dose, titrate slowly with frequent monitoring
  • Severe renal impairment (CLcr < 30 mL/min): Avoid use of lithium.


Source: package insert for each medications mentioned above.

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Dr. Harvinder Singh, M.D. (Admin)

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