# Drug dosing while creatinine is changing

Creatinine lags changes in filtration; ordinary eGFR and Cockcroft–Gault estimates assume steady state. Read the current trajectory, perfusion, congestion, urine output and symptoms, then the medicine’s indication, kidney elimination, toxicity and label-specific renal metric. Severe infection still requires adequate initial therapy; reassess maintenance doses with pharmacy and measure drug levels when useful. AKI and recovery require repeated review and explicit hold, monitoring and restart plans. Do not dose only from an old baseline. Brisk urine output does not prove normal clearance. Gabapentin accumulation may cause somnolence or myoclonus; tacrolimus needs interaction review and a correctly timed trough. A creatinine rise can also reflect secretion or hemodynamic effects.

[KDIGO 2024 CKD](https://kdigo.org/guidelines/ckd-evaluation-and-management/) · [PROGRAF prescribing information](https://dailymed.nlm.nih.gov/dailymed/getFile.cfm?name=PROGRAF&setid=7f667de1-9dfa-4bd6-8ba0-15ee2d78873b)

Andrew Bland, MD, FACP, FAAP