SPS and other information resources can help healthcare professionals provide advice on medicines in renal impairment.

SPS resources

SPS produces a variety of information relating to kidney disorders.

If the information is not available on the SPS website or the information resources listed, or if your clinical scenario is complex, we would suggest you seek further advice from the SPS Medicines Advice service.

Primary resource suggestions

In addition to our own resources, we recommend the following resources for information about specific medicines in renal impairment.

The manufacturers information should always be followed unless a renal specialist advises otherwise. Prescribing or administering a medication outside the manufacturers information may render the medicine being used off-label.

Summary of Product Characteristics (SmPC)

Access online at the electronic Medicines Compendium (emc):

  • gives the UK licensed status of a medicine’s use in renal impairment.  Manufacturers may take a cautious approach because of a lack of clinical trial data
  • the kidney function is expressed as creatinine clearance (CrCl) (mL/min) and based on the Cockcroft and Gault equation for most medicines
  • contains pharmacokinetic data to inform how the medicine will be removed, e.g. amount of parent medicine excreted through the kidneys, how any active metabolites are removed, impact of kidney disease on medication half-life

British National Formulary (BNF)

Access online at BNF to find:

  • brief statements on the use of medicines during renal impairment (based largely on the SmPC)
  • a useful overview on prescribing in renal impairment
  • the kidney function expressed as estimated glomerular filtration rate (eGFR) normalised to a body surface area of 1.73m2

The BNF is rarely used as a sole information source for managing medicines in renal impairment.

Renal Drug Handbook and Renal Drug Database

The Renal Drug Database (subscription required) is available online and as a handbook. Both contain:

  • individual medicine monographs on how to prescribe, prepare and administer the medicine in various types of renal impairment
  • practice-based information for medicine dosing and administration in renal impairment
  • the kidney function expressed as creatinine clearance (CrCl) (mL/min)

Other resources

The following resources will assist in understanding the considerations when managing medicines in renal impairment.

NICE Clinical Knowledge Summaries (CKS)

NICE CKS has guidance on managing Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD).

NICE has published guidelines for AKI and CKD.

UK Renal Pharmacy Group (RPG)

The UKRPG have a set of leaflets summarising key aspects of renal impairment.

Think Kidneys

Think Kidneys is an NHS awareness campaign that provides information on AKI and CKD and how to manage medicines in both situations. They have a checklist for medicines optimisation in people with AKI.

National Kidney Federation (NKF)

The NKF is a charity that provides useful information on commonly prescribed drugs used for kidney disorders. You may come across some specialist medicines and higher than usual doses.

The Royal College of GPs (RCGP)

The RCGP have produced an AKI Toolkit to disseminate learning from AKI cases.

Medicines Learning Portal

The Medicines Learning Portal will support the training of the pharmacy team. It has a tutorial on renal medicine.


Nitrofurantoin can be used during breastfeeding. Recommendations apply to full term and healthy infants.
Support for prescribing decisions in people on interacting medicines, those with swallowing difficulties, renal impairment, or who are pregnant or breastfeeding
SPS PGD template for the supply of trimethoprim tablets for the treatment of Urinary Tract Infection (UTI).
SPS PGD template for the supply of nitrofurantoin capsules/tablets for the treatment of Urinary Tract Infection (UTI).
Oxybutynin is preferred for urinary disorders during breastfeeding. Recommendations apply to full term and healthy infants only.

Update history

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