Can you create a dosing recommendation chart based on laboratory values?

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Last updated: November 12, 2026 • View editorial policy

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Antiretroviral and Antimicrobial Dosing Chart Based on Renal Function

Use creatinine clearance (CrCl) to guide all dosing adjustments for renally-cleared antiretrovirals and antimicrobials in HIV-infected patients with chronic kidney disease. 1, 2

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Lamivudine

Creatinine Clearance Dosing
≥50 mL/min 150 mg PO BID or 300 mg PO daily (no adjustment)
30-49 mL/min 150 mg PO daily
15-29 mL/min 150 mg first dose, then 100 mg PO daily
5-14 mL/min 150 mg first dose, then 50 mg PO daily
<5 mL/min or hemodialysis 50 mg first dose, then 25 mg PO daily
Peritoneal dialysis 50 mg first dose, then 25 mg PO daily

1, 2

Tenofovir Disoproxil Fumarate

Creatinine Clearance Dosing
≥50 mL/min 300 mg PO daily (no adjustment)
30-49 mL/min 300 mg PO every 48 hours
10-29 mL/min 300 mg PO every 72-96 hours
Hemodialysis 300 mg PO every 7 days (give after dialysis)
Peritoneal dialysis Use with caution; dose reduction needed

1, 2

Emtricitabine

Creatinine Clearance Dosing
≥50 mL/min 200 mg PO daily (no adjustment)
30-49 mL/min 200 mg PO every 48 hours
15-29 mL/min 200 mg PO every 72 hours
<15 mL/min or hemodialysis 200 mg PO every 96 hours
Peritoneal dialysis Use with caution; dose reduction needed

1, 2

Zidovudine

Creatinine Clearance Dosing
≥15 mL/min 300 mg PO BID (no adjustment)
<15 mL/min or hemodialysis 100 mg PO every 6-8 hours
Peritoneal dialysis 100 mg PO every 6-8 hours

1, 2

Abacavir

Creatinine Clearance Dosing
All levels 300 mg PO BID or 600 mg PO daily (no adjustment)
Hemodialysis No adjustment
Peritoneal dialysis Use with caution

1, 2

Stavudine (Body Weight ≥60 kg)

Creatinine Clearance Dosing
>50 mL/min 40 mg PO BID (no adjustment)
26-50 mL/min 20 mg PO BID
≤25 mL/min or hemodialysis 20 mg PO daily
Peritoneal dialysis Use with caution; dose reduction needed

1, 2

Didanosine EC (Body Weight ≥60 kg)

Creatinine Clearance Dosing
≥60 mL/min 400 mg PO daily (no adjustment)
30-59 mL/min 200 mg PO daily
10-29 mL/min 125 mg PO daily
<10 mL/min or hemodialysis 125 mg PO daily
Peritoneal dialysis 125 mg PO daily

1, 2

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

No dose adjustment required for nevirapine, efavirenz, or delavirdine at any level of renal function. 1, 2

Protease Inhibitors

No dose adjustment required for indinavir, saquinavir, nelfinavir, amprenavir, fosamprenavir, ritonavir, lopinavir/ritonavir, or atazanavir at any level of renal function. 1, 2

Integrase Inhibitors

No dose adjustment required for raltegravir or dolutegravir at any level of renal function. 2

Key Antimicrobial Agents

Acyclovir (IV)

Creatinine Clearance Dosing
>50 mL/min 5-12.4 mg/kg IV every 8 hours (no adjustment)
10-50 mL/min 5-12.4 mg/kg IV every 12-24 hours
<10 mL/min 2.5-5 mg/kg IV every 24 hours
Hemodialysis Additional dose after each dialysis

1

Ganciclovir (IV)

Creatinine Clearance Dosing
≥70 mL/min 5 mg/kg IV every 12 hours (induction)
50-69 mL/min 2.5 mg/kg IV every 12 hours
25-49 mL/min 2.5 mg/kg IV every 24 hours
10-24 mL/min 1.25 mg/kg IV every 24 hours
<10 mL/min 1.25 mg/kg three times per week after hemodialysis

1

Valganciclovir

Creatinine Clearance Dosing
≥60 mL/min 900 mg PO daily (no adjustment)
40-59 mL/min 450 mg PO daily
25-39 mL/min 450 mg PO daily
10-24 mL/min 450 mg PO twice per week
<10 mL/min or hemodialysis Not recommended

1

Trimethoprim-Sulfamethoxazole (Treatment Dose)

Creatinine Clearance Dosing
>50 mL/min 3-5 mg/kg IV every 6-8 hours (as trimethoprim)
10-50 mL/min 3-5 mg/kg IV every 12 hours
<10 mL/min 3-5 mg/kg IV every 24 hours

1

Fluconazole

Creatinine Clearance Dosing
>50 mL/min 50-400 mg PO/IV daily (no adjustment)
11-50 mL/min 50% of usual dose
≤10 mL/min 50% of usual dose
Hemodialysis Full dose after each dialysis

1

Critical Monitoring Points

Monitor renal function at baseline, then:

  • Every 2-3 times per week during induction therapy with nephrotoxic agents (foscarnet, cidofovir, amphotericin B) 1
  • Every 1-2 weeks during maintenance therapy with nephrotoxic agents 1
  • Every 6 months for indinavir (check for pyuria and renal function) 1
  • When initiating or escalating tenofovir in patients with GFR <90 mL/min 1

Cidofovir is contraindicated when:

  • Baseline creatinine clearance <55 mL/min
  • Serum creatinine >1.5 mg/dL
  • Urine protein ≥2+ (100 mg/dL) on dipstick 1

Discontinue cidofovir if:

  • Serum creatinine increases ≥0.5 mg/dL above baseline
  • Urine protein develops to 3+ 1

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.