More information needed:
ESRD and ART
1. CrCl = 16 ml/min ( ESRD Stage = 4). Losartan is recommend for ESRD. Further review is need to know the blood pressure chart to ensure the blood pressure under control.
Consult nephrologist to start dialysis and losartan cannot be consume prior of dialysis (reduce the AUC)
2. For prolong viral suppression, patient need to take Antiretroviral regimen. Recommend for DTG based regimen ie: DTG/RILPIVIRNE or DTG/3TC
Depression
3. It's okay to continue Mirtazipine, but with lower dose. Recommend to switch for SSRI drug groups because protein bound, metabolise by liver and no affected or affecting by dialysis.
COPD
4. Review the severity of the COPD particularly for past 6 months or a year:
-history of asthma attack
-history of hospitalisation
-lung function test (FEV/FEC)
-compliance and technique of inhaler
-i would recommend to add inhale corticosteroids to Spiriva (ICS-LABA) and discontinue Advair/Proair.
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Akbar Jaya, BPharm (Hons)
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Original Message:
Sent: 07-05-2022 14:38
From: Cameron Staiger
Subject: ESRD on Biktarvy and Advair, atorvastatin
I have an 81 yom who was just recently discontinued on Biktarvy due to CrCl 16 by his nephrologist. Although he was well controlled on it, I am looking for alternatives as his med list has lots of drug interactions with alternatives. What would you recommend for someone who is taking mirtazapine, losartan, atorvastatin, Advair & Proair, and Spiriva? He is not currently on dialysis. Thanks for your help in advance!
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Cameron Staiger, PharmD
Beaufort SC
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