رجل عمره ٧٧ سنة عنده مرض كلى مزمن (eGFR ٢٢)، كُتب له اليوم مضاد حيوي وجابابنتين بالجرعات المعتادة للبالغين. أمس صار نعساناً جداً ومشوشاً ومترنحاً بعد زيادة جرعة الجابابنتين. العلامات الحيوية مستقرة. ما الإجراء الأنسب؟

A 77-year-old man with CKD (eGFR 22) is prescribed today an antibiotic and gabapentin at usual adult doses. Yesterday, after a gabapentin increase, he became very drowsy, confused and unsteady. Vitals are stable. What is the most appropriate action?

1. Double the gabapentin to treat the pain faster
2. Give a stimulant such as coffee to reduce the drowsiness only
3. Give the doses as written because they are standard doses
4. Review doses with the provider or pharmacist according to kidney function

Answer: D) Review doses with the provider or pharmacist according to kidney function. Many drugs are renally cleared (e.g. gabapentin, some antibiotics) and accumulate in CKD, causing toxicity. Doses are adjusted to eGFR.