Levy N B
New York Medical College, Valhalla.
Int J Psychiatry Med. 1990;20(4):325-34. doi: 10.2190/T5TH-9UJY-A3MW-M1PR.
The prescription of medications for a patient with kidney failure requires special consideration since the kidneys are major organs of excretion and regulator the body's fluid environment. Physicians need to have a working knowledge of the pharmacokinetics of the medications they intend to prescribe. Protein binding of medications is a central factor, especially in end-stage kidney disease where its impairment is associated with higher available drug levels. Fortunately, almost all psychotropics are fat soluble, are excreted by the liver and are not dialyzable. Lithium is an exception, but it may be used because it is totally excreted by the kidneys and its dialyzability enables single dosing after dialysis runs. Some benzodiazepines such as diazepam have active metabolites and their use should be avoided. The general rule is that no more than two-thirds of the maximum dose for a patient with normal renal function should be the maximum dose for a hemodialysis patient and that drug levels should be performed at least monthly and immediately after initial dosing.
为肾衰竭患者开药方需要特别考虑，因为肾脏是主要的排泄器官且调节着人体的液体环境。医生需要对他们打算开的药物的药代动力学有实际的了解。药物的蛋白结合是一个核心因素，尤其是在终末期肾病中，其受损与更高的药物可用水平相关。幸运的是，几乎所有精神药物都是脂溶性的，由肝脏排泄且不可透析。锂是个例外，但它可以使用，因为它完全由肾脏排泄，其可透析性使得在透析后能够单次给药。一些苯二氮䓬类药物如地西泮有活性代谢物，应避免使用。一般规则是，肾功能正常患者最大剂量的不超过三分之二应为血液透析患者的最大剂量，并且应至少每月以及在初始给药后立即进行药物水平检测。
