Table 4 |
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Drugs with renally eliminated active or toxic metabolites that may accumulate in AKI |
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Drug |
Drug class |
Accumulated substance |
Clinical consequence of metabolite accumulation |
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Allopurinol |
Xanthine oxidase inhibitor |
Active metabolite oxypurinol |
Increased risk for immune-mediated hypersensitivity reaction |
|
Codeine |
Opioid analgesic |
Active metabolites norcodeine and morphine |
CNS depression, respiratory depression |
|
Dolasetron |
Antiemetic |
Active metabolite hydrodolasetron |
Q-T prolongation/ECG changes |
|
Meperidine |
Opioid analgesic |
Toxic metabolite normeperidine |
Anxiety, agitation, tremors, twitches, myoclonus, seizure |
|
Midazolam |
Benzodiazepine |
Active metabolites 1-hydroxymidazolam and 1-hydroxymidazolamglucuronide |
Apnea, sedation, drowsiness |
|
Morphine |
Opioid analgesic |
Active metabolite morphine-6-glucuronide |
CNS depression, respiratory depression |
|
Mycophenolate mofetil/mycophenolic acid |
Immunosuppressant |
Inactive glucuronide metabolite displacing mycophenolic acid from albumin and resulting in increased free mycophenolic acid concentration |
Leukopenia |
|
Procainamide |
Anti-arrhythmic |
Active metabolite N-acetyl procainamide (NAPA) |
Sinus bradycardia, sinus node arrest, Q-T interval prolongation |
|
Propoxyphene |
Opioid analgesic |
Active metabolite norpropoxyphene |
Cardiotoxicity resulting in dysrhythmias |
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Quinidine |
Anti-arrhythmic, antimalarial |
Active metabolite 3-hydroxy quinidine |
Additive Q-T interval prolongation |
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Voriconazole – intravenous formulation |
Antifungal |
Vehicle sulfobutyl ether β-cyclodextran sodium (SBECD) |
Demonstrated proximal tubule toxicity in rats |
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Vilay et al. Critical Care 2008 12:235 doi:10.1186/cc7093 |
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