In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.
If worsening renal function, actual GFR is likely lower than calculated.
If improving renal function, actual GFR is likely higher than calculated eGFR.
0 - 10 eGFR
250mg PO q24h
10+ eGFR
500mg PO BID
0 - 10 eGFR
0.75-1.5g IV q24h
10 - 20 eGFR
0.75-1.5g IV q12h
20+ eGFR
0.75-1.5g IV q8h
750-1500mg IV q24h, give dose after HD on dialysis days
750mg PO after HD
750-1500mg IV q8h