Last update : 2017-09-27
RenadaptorⒸ is a software database, purely consultative, containing more then 1800 records concerning currently more than 1400 drugs. The use of the database is intuitive, easy and contains only information that is useful for prescribing medication.
Using RenadaptorⒸ is over all individual and intended for prescribing practitioners and clinical pharmacists. It is possible to integrate this database in a computerized physician order entry system (CPOE).
All pharmacotherapeutic classes are represented. One active ingredient of a drug can have several records, depending on the administration mode, and varying indications with very large dosages differences.
The search can be done by keyword or by typing directly the drug INN name (Figure 1). It is also possible to search by therapeutic class. You can even search the brand name of the drug since brand names for more than 30 countries are listed in the database.
Figure 1: Search screen
Once the search completed, the drug or drugs you searched for are displayed in a list, in which the active ingredients can be sorted by alphabet or by therapeutic subclass (Figure 2).
A 3 colour code allows you to see at a glance if the dosage has to be adjusted or if the drug is contra-indicated. If the record is green, no adjustment has to be done. If the record is orange, an adjustment is necessary considering the 5 different stages of renal failure and/or a dialysis technique. If the record is red, the drug is contra-indicated for at least one of the 5 stages of renal failure or in dialysis. A selection by colour is then possible.
Figure 2: List screen
Clicking on a drug name of the list screen, display the details of that specific record.
One record is composed of two pages :
The first page (Figure 3), the main page, goes straight to the point. You will find:
- The molecule classified by specialty, according to its pharmacological properties.
- Laboratory tests (therapeutic drug monitoring ...) and their goal range, used to adjust the drug dosage.
- The mode of administration (Oral, IV, SC, IM, ...)
- The loading dose.
- The maintenance dose for healthy subjects.
- The maintenance doses adjusted to the 5 stages of renal failure (GFR in ml/min) and to the different dialysis techniques
(hemodialysis, peritoneal dialysis, CRRT).
- The maintenance doses for severe liver failure (Child-Pugh class B/C) and for mixed hepatorenal failure.
- A simplified indication (-, +, ++, +++) about detoxification possibilities with an extracorporeal technique
(hemodialysis, CRRT, Charcoal hemoperfusion, plasmapheresis).
Figure 3: Card screen
Adjustments of the maintenance dose are done by changing the dosage and/or by changing the interval between every dose, depending on the pharmacodynamic and pharmacokinetic properties of the drug. It is also based on practical modalities, especially for dialysis patients (ex IV injections post dialysis). The proposed maintenance dosages are presented as the extreme range of dose and extreme range of administration frequency, all similar indications envisaged. So, the clinician has to refine the dosage while taking into account the characteristics of his patient (age, gender, weight, etc..) and the specific medical indication.
The proposed dosages are based the EMA and FDA approved monographs, and on the most recent medical and pharmaceutical literature.
When no data are available and in the absence of a strict contra-indication, the proposed dosages are based on a detailed pharmacodynamic and pharmacokinetic analysis of the drug and/or on the experience of the authors (this is mentioned with ¬´!!!¬ª).
Proposed dosages are intended for adults and may not be applicable for paediatric use!
The adjusted dosages are intended for subjects with chronic stable renal failure. Acute kidney injury is excluded except for the oligo-anuric dialysed patient for whom dialysis doses may be proposed. When the patient is recovering from acute kidney injury, no standard recommendation may be done.
It is possible to search by therapeutic class by clicking on the corresponding checkbox in the list screen as well as in the card and info screens. This function is useful for a rapid search for a new molecule within the same therapeutic class (for example when a first search resulted in a contra-indication).
The second page of each record contains complementary information (Figure 4):
- Brand names for more than 30 countries in the world.
- A summary of physicochemical, pharmacokinetic and toxicological properties.
- Specific scientific references.
Figure 4: Info screen
The software is translated in 4 languages (French, English, German and Dutch).
Drugs of topical use (dermatology, ophthalmology, aeroso, ...) and vaccines are yet not included because their use is merely not different from non uremic patients.
Keep in mind that 'killed vaccines' can be administered in double dosages while the 'live' ones are sometimes prohibited due to renal failure immunodeficiency.
Some specific tabs are also available on the toolbar :
- 'Introduction and Presentation' : contains basic information about how to adjust medication to renal failure.
- 'Help' : gives information about the use of the software and its different tabs.
- 'About us' : is a presentation of the medical and IT team who manages the database.
- 'Legal notice' : resumes the usage limits of the presented data.
- 'References' : is a list of the main consulted medical and pharmacological references.
- 'Contacts' : gives the possibility to contact the authors, to write a comment or ask a question in a specific area which will then
be directly sent to the managers of the database.
The database was created and is being updated by a team of 4 nephrologists and 1 infectiologist. The IT management is done by a team of computer specialists.
The major advantages of RenadaptorⒸ are its accessibility and its ease to use.
All efforts are being made to ensure accurate and complete information, but no guarantee is given in this field.
This tool has no other ambition than being a help for clinicians, while prescribing drugs to renal failure patients.
Brand names are only mentioned in order to help searching for a drug in the database. Despite efforts to be exhaustive, the correspondence between the brand name and the molecule (INN) is not fully guaranteed.
The authors, the editor and all the suppliers of the present database can not be held responsible if therapeutic or other accidents would occur, nor can they be held responsible for all possible consequences due to the use or non-use of the software and its contents.
No guarantee is given concerning possible updates and the delay of the updates if any.
The use of the software and the content of the database in any form whatsoever is the responsibility of the user.
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