How should rebamipide be dosed and monitored in adults with chronic kidney disease (CKD) (eGFR ≥30 mL/min/1.73 m² and eGFR < 30 mL/min/1.73 m²), including patients on dialysis, and in pediatric patients with renal disease?

Rebamipide Use in Renal Disease

Critical Finding: No Evidence Available

The provided evidence contains no information about rebamipide dosing, safety, or monitoring in patients with chronic kidney disease, dialysis, or pediatric renal disease. All guideline and research evidence provided addresses unrelated medications (tuberculosis drugs, diabetes medications, hepatitis C treatments, gout medications, and general renal dosing principles), but rebamipide is not mentioned in any source.

General Principles for Renally-Cleared Medications

While specific rebamipide guidance is absent, the following framework applies to medications requiring renal dose adjustment:

Assessment of Renal Function

• Calculate eGFR using the CKD-EPI equation and convert indexed eGFR (mL/min/1.73 m²) to non-indexed eGFR (mL/min) by multiplying by the patient's body surface area for accurate drug dosing 1
• Serum creatinine alone is inadequate as it only rises after >50% loss of glomerular function and varies by age, gender, weight, and race 2

Dosing Adjustment Strategies

• For medications cleared renally, adjust doses according to creatinine clearance or GFR using online or electronic calculators 3
• Maintenance dosing adjustments include dose reductions, lengthening the dosing interval, or both 3
• Approximately 60% of regularly used drugs are excreted by the kidney and require dose adjustment to avoid adverse effects 2

Monitoring Requirements

• Drug dosing errors are common in patients with renal impairment and can cause adverse effects and poor outcomes 3
• Renal impairment is a common risk factor for medication safety, with >60% of patients showing renal drug-related problems at hospital admission 1

Clinical Recommendation

Without manufacturer labeling or published pharmacokinetic data for rebamipide in renal disease, prescribing this medication to patients with CKD (eGFR <60 mL/min/1.73 m²), severe renal impairment (eGFR <30 mL/min/1.73 m²), or dialysis-dependent patients cannot be recommended. Contact the drug manufacturer for specific guidance or consider alternative gastroprotective agents with established renal dosing recommendations.