Table 3 Top 10 most frequently prescribed drugs in the elderly outpatients (≥70 years) that require dose adaptation in patients with renal impairment^a

1

furosemide

10–30 ml/min

Starting dose as in normal renal function.

If necessary, increase the dose guided by effect and indication.

In case the effect is inadequate, replace furosemide by bumetanide.

2

metformin

30–50 ml/min

Starting dose 2 × 500 mg metformin

Then, increase the dose gradually to a standard maintenance dose.

10–30 ml/min

Contraindicated.

3

hydrochlorothiazide

10–30 ml/min

Avoid hydrochlorothiazide

4

enalapril

30–50 ml/min

Starting dose is 5 mg once daily.

If necessary, increase the dose guided by clinical effect.

If the prescriber is a general practitioner the maximum dose is 10 mg.

If the prescriber is a specialized physician the dose may be higher.

10–30 ml/min

Starting dose is 2.5 mg once daily.

If necessary, increase the dose guided by clinical effect.

If the prescriber is a general practitioner the maximum dose is 5 mg.

If the prescriber is a specialized physician the dose may be higher.

5

perindopril

30–50 ml/min

If the prescriber is a general practitioner the maximum dose is 2 mg.

If the prescriber is a specialized physician the dose may be higher.

10–30 ml/min

If the prescriber is a general practitioner the maximum dose is 2 mg every 48 h.

If the prescriber is a specialized physician the dose may be higher.

6

digoxin

10–50 ml/min

After digitalization, the starting dose is 0.125 mg once daily.

Then, dose adjustment guided by clinical effect.

7

bumetanide

10–30 ml/min

Starting dose as in normal renal function.

If necessary, increase the dose to a maximum of 10 mg per day.

8

bisoprolol

10–30 ml/min

Starting dose 50 % of the dose as in normal renal function

If necessary, increase the dose to a maximum of 10 mg per day.

9

alendronic acid

10–30 ml/min

Use is not recommended.

10

spironolacton

10–50 ml/min

Monitor serum potassium levels regularly.