Loading doses usually do not need to be 
adjusted in patients with chronic kidney disease. Published guidelines suggest methods 
for maintenance dosing adjustments: dose 
reduction, lengthening the dosing interval, 
or both.
4
 Dose reduction involves reducing 
each dose while maintaining the normal 
dosing interval. This approach maintains 
more constant drug concentrations, but it is 
associated with a higher risk of toxicities if 
the dosing interval is inadequate to allow for 
drug elimination. Normal doses are maintained with the extended interval method, 
but the dosing interval is lengthened to allow 
time for drug elimination before redosing. 
Lengthening the dosing interval has been 
associated with a lower risk of toxicities 
but a higher risk of subtherapeutic drug