Key points
- For the kidney, most labels use the Cockcroft-Gault creatinine clearance [1, 2].
- Always calculate carboplatin with the Calvert formula [3].
- In hepatic impairment, both bilirubin and liver enzymes matter; drugs with hepatic elimination (taxanes, anthracyclines, vinca alkaloids) need the most adjustment [1].
- This table is a summary; check the label of the drug before prescribing.
Renal impairment
| Drug | Adjustment |
|---|---|
| Carboplatin | Calvert formula with GFR [3] |
| Cisplatin | Below 60: usually dose reduction or substitution with carboplatin; below 30 to 45: avoid |
| Capecitabine | 30 to 50: 75% of the dose; below 30: contraindicated |
| Pemetrexed | Below 45: do not use |
| High-dose methotrexate | Below 60: usually avoid, or reduce markedly with drug level monitoring |
| Lenalidomide (myeloma) | 30 to 60: 10 mg daily; below 30 not on dialysis: 15 mg every other day; dialysis: 5 mg daily after dialysis |
| Etoposide | 15 to 50: 75% of the dose |
| Oxaliplatin | Below 30: 65 mg/m² |
| Bleomycin | Below 50: dose reduction and more caution for pulmonary toxicity |
| IV topotecan | 20 to 39: 0.75 mg/m² |
| Zoledronic acid | Reduce according to clearance; below 30: avoid |
Hepatic impairment
| Drug | Adjustment |
|---|---|
| Doxorubicin | Bilirubin 1.2 to 3 mg/dL: 50%; 3.1 to 5: 25%; above 5: contraindicated |
| Docetaxel | Bilirubin above normal, or AST/ALT above 1.5 × with alkaline phosphatase above 2.5 ×: do not give |
| Paclitaxel | Reduce according to bilirubin and enzymes, as in the label table |
| Vincristine | Bilirubin above 3 mg/dL: 50% |
| Irinotecan | Raised bilirubin: reduce the dose or avoid (risk of severe neutropenia) |
| Bortezomib | Moderate or severe impairment: start at 0.7 mg/m² |
Calculators: creatinine clearance · carboplatin dose · Child-Pugh
References
3 referencesShow all references, 1 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2Prediction of creatinine clearance from serum creatinine
- 3Carboplatin dosage: prospective evaluation of a simple formula based on renal function
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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