Neurol. praxi. 2025;26(6):505-514 | DOI: 10.36290/neu.2025.065

Altered pharmacokinetics of selected neurological drugs in patients with chronic kidney disease

Mgr. Michaela Jelínková1, 2, PharmDr. Alena Pilková,Ph.D.2, PharmDr. Jan Miroslav Hartinger, Ph.D.2
1 Oddělení klinické farmacie, Fakultní nemocnice Královské Vinohrady, Praha
2 Farmakologický ústav 1. LF UK a VFN Praha

Chronic kidney disease significantly affects the pharmacokinetics of various neurological drugs, necessitating careful dosage adjustments. Due to reduced renal clearance, drugs eliminated via the kidneys experience prolonged biological half-lives and accumulation, increasing the risk of toxicity or delaying therapeutic effects. Hypoalbuminemia leads to an increased free fraction of drugs bound to plasma proteins, further complicating accurate interpretation of therapeutic drug levels, as demonstrated with valproic acid. The article addresses the impact of impaired renal function and extracorporeal elimination methods on neurologic renally eliminated drugs. Presented case studies illustrate clinical consequences of improperly adjusted drug dosages, including severe adverse effects.

Keywords: chronic kidney disease, hemodialysis, pharmacokinetics, neurological drugs, antiseizure drugs, antiparkinson drugs.

Received: July 6, 2025; Revised: August 11, 2025; Accepted: August 14, 2025; Prepublished online: August 14, 2025; Published: December 15, 2025  Show citation

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Jelínková M, Pilková A, Hartinger JM. Altered pharmacokinetics of selected neurological drugs in patients with chronic kidney disease. Neurol. praxi. 2025;26(6):505-514. doi: 10.36290/neu.2025.065.
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