Augmentin (Amoxicillin/Clavulanate) Dosage Adjustment in Renal Impairment
Yes, Augmentin (amoxicillin/clavulanate) requires dosage adjustment in patients with impaired renal function, especially those with severe renal impairment (GFR < 30 mL/min). 1
Renal Adjustment Guidelines
- Amoxicillin is primarily eliminated by the kidney, making dosage adjustment necessary in patients with severe renal impairment (GFR < 30 mL/min) 1
- The FDA label specifically states that "care should be taken in dose selection" for elderly patients who are more likely to have decreased renal function 1
- Patients with impaired renal function are at higher risk for drug accumulation and toxicity due to decreased renal clearance of amoxicillin and clavulanate potassium 1
Clinical Considerations
- High blood levels of amoxicillin/clavulanate may occur more readily in patients with impaired renal function due to decreased renal clearance 1
- Inappropriate dosing in patients with renal dysfunction can lead to toxicity or ineffective therapy, necessitating careful adjustment based on remaining kidney function 2
- Crystalluria, potentially leading to renal failure, has been reported after amoxicillin/clavulanate overdosage, highlighting the importance of proper dosing in patients with already compromised renal function 1
Monitoring Recommendations
- In patients with renal impairment, adequate fluid intake and diuresis should be maintained to reduce the risk of amoxicillin/clavulanate crystalluria 1
- Regular monitoring of renal function is recommended when administering Augmentin to patients with impaired renal function 1
- Serum drug concentrations should be monitored in patients with severe renal impairment to avoid toxicity 3
Special Populations
- Neonates and young infants require special consideration due to incompletely developed renal function, which may delay amoxicillin elimination (though clavulanate elimination is unaltered in this age group) 1
- Elderly patients require particular attention as they are more likely to have decreased renal function and therefore higher risk of adverse reactions 1
Important Caveats
- Amoxicillin/clavulanate can be removed from circulation by hemodialysis, which should be considered when dosing patients on dialysis 1
- Dosage adjustment is typically based on glomerular filtration rate (GFR), most commonly estimated using the Cockroft-Gault formula 2
- Even with appropriate dosage adjustments, adverse drug reactions remain common in patients with renal dysfunction 2