Gout, GI, Oncology & Other Renal Dosing by Creatinine Clearance

This chart covers renal dose adjustment for the 12 gout, GI, oncology & other in this registry: Alendronate, Allopurinol, Carboplatin, Cimetidine, Cisplatin, Colchicine, Famotidine, Febuxostat, Hydrochlorothiazide, Methotrexate, Varenicline and Zoledronic Acid. Of these, 9 are dosed by creatinine clearance from Cockcroft-Gault; 1 is labelled by eGFR in mL/min/1.73m² (Hydrochlorothiazide); 1 is dosed from GFR with the Calvert formula (Carboplatin); and 1 has no CrCl dose band (Febuxostat). Each drug links to its own page with the full threshold, cautions, and an FDA-label reference.

Reviewed and approved by Dr. Rishi Kumar Kafle, MBBS, MD, FASN. Always confirm against the label.

Gout, GI, Oncology & Other: renal dosing chart

Cutoffs That Change Gout, GI, Oncology & Other Doses

The rules above name 4 creatinine clearance cutoffs, from 60 down to 30 mL/min. Each line lists the drugs whose rule changes at that value:

• 60 mL/min: Cisplatin
• 50 mL/min: Famotidine
• 35 mL/min: Alendronate and Zoledronic Acid
• 30 mL/min: Methotrexate and Varenicline

The eGFR-labelled agents use one cutoff in mL/min/1.73m²:

• eGFR 30: Hydrochlorothiazide

Rules without a numeric renal-function cutoff: Allopurinol, Cimetidine, Colchicine and Febuxostat. Read their full rule in the chart and on each drug page. A cutoff that sits between two bands still needs the label wording, because some labels use "less than" and others "at or below" the value.

Worked Example: Gout, GI, Oncology & Other at a CrCl of About 49 mL/min

A 70-year-old man weighing 70 kg with a serum creatinine of 1.4 mg/dL has a Cockcroft-Gault creatinine clearance of about 49 mL/min. The rules to check first are those with a numbered step above that value: Cisplatin (60 mL/min) and Famotidine (50 mL/min). The numbered steps of Alendronate (35 mL/min), Varenicline (30 mL/min) and Zoledronic Acid (35 mL/min) sit lower, so they matter as clearance falls further. Allopurinol, Cimetidine, Colchicine and Methotrexate name a reduction that is not tied to a single CrCl cutoff, so read the full rule at any clearance. The eGFR-labelled agents need an eGFR estimate instead of this figure.

How the Gout, GI, Oncology & Other Cutoffs Compare With the Standard Bands

Many renally cleared drugs follow four broad creatinine clearance bands: above 50, 30-50, 15-30, and below 15 mL/min. Of the 4 CrCl cutoffs named in this class, 2 sit on a standard band edge (50 and 30 mL/min) and 2 do not (60 and 35 mL/min), so the generic bands are only a rough guide for gout, GI, oncology & other. Where a drug's own cutoff and the generic band disagree, the drug's cutoff takes precedence.

Avoidance, Dialysis and Monitoring Notes

• Avoid or contraindicated: Alendronate (Avoid CrCl <35); Cisplatin (Avoid/adjust <60); Colchicine (avoid prophylaxis in severe CKD); Methotrexate (avoid <30 (oncology)); Zoledronic Acid (Avoid/contraindicated CrCl <35 (osteoporosis)).
• Dialysis: no gout, GI, oncology & other rule here mentions dialysis, so take dialysis dosing from each label.
• Levels and monitoring: Carboplatin (Calvert: dose = AUC x (GFR + 25)).
• Shared cautions: nephrotoxic (Cisplatin and Zoledronic Acid).

Which Renal Estimate the Labels Use for Gout, GI, Oncology & Other

Use the eGFR calculator for the eGFR-labelled agents and the creatinine clearance calculator for the rest. The two estimates can differ markedly in small, large, elderly or frail patients; see how creatinine clearance differs from eGFR. Carboplatin is dosed with the Calvert formula calculator instead.

Where These Thresholds Come From

The 12 rules for gout, GI, oncology & other were compiled from the FDA label (6 drugs), standard clinical pharmacology references (4 drugs) and the Pharmacy Times renal dosing reference (2 drugs). Thresholds cross-checked against the FDA label or a guideline source: Allopurinol and Colchicine. Every value has been reviewed by a clinician, and each drug page links its label through DailyMed.

How Reduced Kidney Function Affects Gout, GI, Oncology & Other

Renal impairment slows the elimination of gout, GI, oncology & other and of any active metabolites the kidney clears. It also shifts the balance of benefit and harm, so dose-related adverse effects become more likely at the same nominal dose. The chart above gives the key caution for each agent. When one agent must be avoided below a cutoff, another in the class may be safer, so weigh the indication, the patient's trajectory, and monitoring availability. Record the estimate, the equation, the weight, and the date behind each dose, and re-estimate once a changing creatinine settles.

Calculate the Patient's CrCl First

Estimate creatinine clearance with the Cockcroft-Gault equation and the right dosing weight. Use actual body weight when it is below ideal body weight, ideal body weight up to 130% of ideal, and adjusted body weight above 130% of ideal, as in obesity. Re-estimate whenever kidney function may have changed, since acute illness and dehydration can lower clearance within days.

Related classes: Neurology & Pain renal dosing (neurology and pain drugs with CrCl cutoffs).