Hemodialysis

During hemodialysis, there may be an initial lowering of the plasma drug concentration, followed by a rebound after dialysis. Most psychotropic medications are highly protein bound and not significantly cleared by dialysis. In contrast, lithium, gabapentin, and topiramate are completely removed by dialysis, with the common practice being to administer these medications after dialysis (Levy 1990). Drugs with a narrow therapeutic index should be avoided wherever possible in dialysis patients. In addition, patients on dialysis often have significant fluid shifts and are at risk of dehydration, with neuroleptic malignant syndrome being more likely in these situations (Kunishima et al. 2000). Another common issue is that of orthostatic hypotension that occurs particularly following dialysis.

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