From the Research
Chlorpheniramine maleate can be used in hemodialysis patients but requires dose adjustment, with a recommended dose of 4 mg every 12-24 hours, which is about half the normal dose, as supported by the study 1. The medication is not significantly removed by hemodialysis, so supplemental doses after dialysis sessions are not necessary.
- Chlorpheniramine is primarily metabolized by the liver, but some metabolites are excreted by the kidneys, which is why dose reduction is needed in renal impairment.
- Patients on hemodialysis should be monitored for increased side effects such as sedation, dry mouth, urinary retention, and confusion, which may be more pronounced due to decreased drug clearance.
- These anticholinergic side effects may be particularly problematic in elderly dialysis patients. If the patient experiences excessive drowsiness or other intolerable side effects, consider switching to a second-generation antihistamine with less CNS penetration, such as loratadine or cetirizine, with appropriate renal dosing adjustments, as suggested by studies 2, 3, 4. However, the most recent study 5 emphasizes the importance of adapting drug treatments for patients on hemodialysis with multiple chronic pathologies, and considering the pharmacokinetics of the chosen drug. Therefore, it is crucial to carefully evaluate the patient's individual needs and adjust the treatment plan accordingly, taking into account the potential risks and benefits of each medication, as well as the patient's overall health status and quality of life.