In this post, I will share some questions that I would investigate from this medication list. I have many questions surrounding renal concerns given the use of sevelamer.
- Metformin (Glucophage): 500 mg twice daily
- Glipizide (Glucotrol): 5 mg once daily
- Insulin glargine (Lantus): 10 units once daily
- Sitagliptin (Januvia): 100 mg once daily
- Lisinopril (Prinivil, Zestril): 10 mg once daily
- Amlodipine (Norvasc): 5 mg once daily
- Losartan (Cozaar): 50 mg once daily
- Hydrochlorothiazide (Microzide): 25 mg once daily
- Ibuprofen (Advil, Motrin): 200 mg every 4-6 hours as needed
- Omeprazole (Prilosec): 20 mg once daily
- Alendronate (Fosamax): 70 mg once weekly
- Sevelamer (Renvela): 800 mg three times daily with meals
Sevelamer is a phosphate binder that is typically used to lower phosphate levels for patients with CKD. If this patient truly has CKD and significant impairment, many medications should be reassessed. The first medication to look at is ibuprofen. Ibuprofen is an NSAID that should be avoided in patients with significant renal impairment. It can exacerbate renal failure and increase the risk of acute renal failure.
My first look at this diabetes regimen makes me cringe a little. Metformin also requires dose adjustments or avoidance altogether in patients with poor renal function. I would likely try to avoid this medication in this patient depending upon the renal function. I don’t particularly appreciate using a sulfonylurea with insulin. The sevelamer tells me the renal function is likely pretty poor and sitagliptin also requires renal function adjustments. A GLP-1 agonist would potentially make some sense in this case if we need to get rid of the metformin, glipizide, and/or sitagliptin. If a GLP-1 is initiated, it is recommended to avoid the use of DPP-4 inhibitors like sitagliptin as they affect the same pathway and have similar effects.
Alendronate and hydrochlorothiazide are two other medications that would likely be avoided in a patient with renal concerns. It would be important to dig into the history of these medications as well.
What other questions do you have with this medication list?
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I would also assess need for PPI given the potential risk of worsening ckd. Possibly discontinue or switch to h2 blocker.
Patient is on both lisinopril and losartan, two additional medications that may affect renal function.