DRUG-INDUCED ALTERATIONS IN SERUM CREATININE CONCENTRATIONS

OBJECTIVE: To provide a comprehensive review of drug-induced alteratio ns in serum creatinine concentrations (SCrs). DATA SOURCES: Informatio n was obtained from a MEDLINE search, reference lists from articles id entified in the search, review articles, and abstracts. STUDY SELECTIO N: Emphasis was placed on clinical studies of direct relevance to clin ical practitioners. DATA EXTRACTION: Literature was assessed for its m ethodology, results, discussion, and conclusion. DATA SYNTHESIS: Two a nalytical systems to assay SCr are commonly employed in clinical pract ice-the Jaffe-based and enzymatic methods. Several drugs have been rep orted to interfere with SCr results obtained with both analytical syst ems by producing assay interference. In addition, trimethoprim, cimeti dine, and salicylates produce elevations in the SCr by altering the no rmal elimination pathways of creatinine. Phenacemide has been reported to increase creatinine elimination, but the mechanism of this effect is unknown. CONCLUSIONS: Pharmacists should recognize the clinical sig nificance of drug-induced interference with SCr and propose alternativ e methods of determining concentrations in selected patients.