EpistemisIntegrated Fit and Safety Summary
Quick reference tool for the specialist to verify the dose adjustment requirements in renal and hepatic failure and the safety category in pregnancy.
File
| Drug | Renal Adjustment (eGFR cutoff) | Liver Adjustment | Pregnancy (FDA / PLLR) | Major Critical Toxicity |
|---|---|---|---|---|
| Metformin | Contraindicated to eGFR < 30 mL/min | Avoid in severe insufficiency | Category B (Compatible, prefer insulin) | Lactic acidosis (BAD) |
| Empagliflozin | No efficacy at eGFR < 20 mL/min | No dosage adjustment required | Not recommended (Fetal tubular risk) | Euglycemic ketoacidosis, Fournier |
| Semaglutide | No dosage adjustment required | No dosage adjustment required | Contraindicated (Discontinue 2 months before) | Pancreatitis, Medullary Thyroid Ca (CMT) |
| Sitagliptin | Reduce by 50% in eGFR < 45; 25% in eGFR < 30 | No dosage adjustment required | Category B (Avoid) | Acute pancreatitis, severe arthralgia |
| Glimepiride | Avoid if eGFR < 30 mL/min | Contraindicated in severe failure | Contraindicated (neonatal hypoglycemia) | Refractory hypoglycemia |
| Pioglitazone | No dosage adjustment required | Do not use if transaminases > 2.5x ULN | Contraindicated (Embryonic death) | Fluid Retention, Heart Failure |
| L-Thyroxine | No dosage adjustment required | No dosage adjustment required | Category A (Increase dose 30-50%) | Induced thyrotoxicosis, AF, Angina |
| Methimazole | No dosage adjustment required | Use with caution | Of choice in T2 and T3 (Teratogen in T1) | Febrile agranulocytosis, Aplasia cutis |
| Hydrocortisone | No dosage adjustment required | Decrease dose in active cirrhosis | Compatible (Inactivated by 11β-HSD2) | Acute adrenal crisis due to sudden suppression |
| Desmopressin | Contraindicated if eGFR < 50 mL/min | No dosage adjustment required | Compatible (Central DI of choice) | Extreme dilutional hyponatremia, seizures |
| Ac. Zoledronic | Contraindicated if eGFR < 35 mL/min | No dosage adjustment required | Contraindicated (Fetal skeletal risk) | Acute phase, Jaw necrosis (ONJ) |
| Denosumab | No adjustment required (Monitor serum calcium) | No dosage adjustment required | Contraindicated (Fetal immune failure) | Hypocalcemia, Rebound of multiple fractures |
| Cinacalcet | No adjustment required (Designed for dialysis) | Monitor in moderate-severe insufficiency | Not recommended | Symptomatic hypocalcemia, Tetany, QTc |
| Atorvastatin | No dosage adjustment required | Contraindicated in active disease | Category X (Absolute contraindication) | Toxic myopathy, Rhabdomyolysis |
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.
- System
- Endocrine and Metabolism
- Cluster
- Comparative Table of Clinical Settings