Vancomycin accumulates in renal failure and is nephrotoxic and ototoxic.
Cimetidine may precipitate an acute encephalopathy; ranitidine is also retained but toxicity is less.
Higher doses of loop diuretics such as furosemide are needed to effect a diuresis in uraemic patients. Infuse slowly to avoid ototoxicity.
Digitoxin is cleared in the liver, but 10% is metabolised to digoxin and so, although modification of the dose is seldom needed, levels should be monitored.
Indomethacin does not accumulate in renal failure but it should be used with great caution in view of the increased prevalence of peptic ulceration in uraemia.