EpistemisIntegrated Summary of Clinical Adjustment and Safety
Quick consultation tool for medical specialists to make complex clinical decisions regarding cardiovascular pharmacological prescription.
File
| Drug | Dose Adjustment in Renal Failure (eGFR cutoff) | Dose Adjustment in Liver Failure | Pregnancy (FDA / PLLR) | Major Critical Toxicity |
|---|---|---|---|---|
| Enalapril / Ramipril | Initial dose reduced to eGFR < 30 mL/min | Requires hepatic hydrolysis for activation | Absolutely contraindicated (Teratogenicity) | Dry cough, Angioedema, Hyperkalemia |
| Losartan / Valsartan | No initial adjustment required | Initial dose reduced to 25 mg in losartan for cirrhosis | Absolutely contraindicated | Hyperkalemia, Acute hypotension |
| Sacubitril / Valsartan | Initial dose reduced to 24/26 mg if eGFR < 30 mL/min | Reduced starting dose if Child-Pugh Class B | Absolutely contraindicated | Profound hypotension, Angioedema (co-ACEI) |
| Spironolactone / Eplerenone | Contraindicated if eGFR < 30 mL/min base | Avoid eplerenone with strong CYP3A4 inhibitors | Avoid routine use | Severe hyperkalemia, Gynecomastia (spiro) |
| Carvedilol / Metoprolol | No dosage adjustment required | Contraindicated in severe liver failure (carvedilol) | Compatible under strict fetal rate control | Extreme bradycardia, Bronchospasm, Rebound |
| Amlodipine / Nifedipine | No dosage adjustment required | Initial dose reduced to 2.5 mg in amlodipine | Compatible of choice in gestational hypertension | Bilateral malleolar edema, facial flushing |
| Verapamil / Diltiazem | No dosage adjustment required | Slow titration due to extensive metabolism | Avoid routine use | Severe AV block, Constipation (verapamil) |
| Furosemide | Requires high initial doses if eGFR < 30 mL/min | No adjustment required (caution in encephalopathy) | Compatible (use only if essential) | Ototoxicity, Dehydration, Hypokalemia |
| HCTZ / Chlorthalidone | Loses diuretic efficacy at eGFR < 30 mL/min | No dosage adjustment required | Avoid its use during pregnancy | Dilutional hyponatremia, Hypokalemia, Gout |
| Empagliflozin / Dapagliflozin | No efficacy if eGFR < 20-25 mL/min of base | No dosage adjustment required | Contraindicated due to potential fetal renal toxicity | Euglycemic ketoacidosis, Urogenital candidiasis |
| Acetylsalicylic acid | Avoid if eGFR < 10 mL/min base | Avoid in active decompensated cirrhosis | Low dose compatible; contraindicated anti-inflammatory dose | Digestive bleeding, Asthma due to ASA (Samter) |
| Clopidogrel / Ticagrelor | No dosage adjustment required | Avoid in severe liver failure | Avoid routine use | Major hemorrhage, Benign dyspnea (ticagrelor) |
| Rivaroxaban / Apixaban | Contraindicated if eGFR < 15 mL/min base | Contraindicated in Child-Pugh Class C | Absolutely contraindicated | Major bleeding of digestive or systemic location |
| Heparin / Enoxaparin | Enoxaparin requires adjustment to 1 mg/kg/day if eGFR < 30 | UFH preferred in basic coagulation failures | Enoxaparin of choice for not crossing the placenta | Hemorrhage, Heparin-induced thrombocytopenia |
| Amiodarone | No dosage adjustment required | Avoid in severe insufficiency due to bile deposition | Contraindicated due to induction of neonatal fetal goiter | Interstitial pneumonitis, Thyroid dysfunction (TIA) |
| Digoxin | Reduce dose to 50-75% if eGFR < 30-50 mL/min | No dosage adjustment required | Compatible under close blood monitoring | Digital poisoning, AV block, Xanthopsia |
| Nitroglycerin / Nitroprusside | Avoid nitroprusside due to thiocyanate accumulation | Avoid nitroprusside in acute liver failure | Compatible in hypertensive emergencies | Cyanide (nitroprusside) poisoning, Tolerance |
Epistemis is educational review material. It is not a medical device, does not diagnose or prescribe treatment, and does not replace formal medical training, current clinical guidelines, or professional clinical judgment.
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