Electronic Supplementary Material Appendix S1. Prescribing recommendation for renally cleared medications examined in the studya

Drugs / Creatinine Clearance, mL/min / Maximum dosing recommendation, mg
Metformin / 60–90 / 2000 daily
30-60 / 1000 daily
<30 / Avoid use
Glibenclamide / ≤50 / Avoid use
Saxagliptin / <50 / 2.5 once daily
Sitagliptin / 30–50 / 50 once daily
<30 / 25 once daily
Vildagliptin / <50 / 50 once daily
Perindopril / 30–60 / 2.5/2 mg once daily
15–30 / 2.5/2 mg alternate days
<15 / 2.5/2 mg on day of dialysis
Olmesartan / <30 / Avoid use
Valsartan / <30 / 80 once daily
Fenofibrate / 20–60 / 96 once daily
10–20 / 48 once daily
<10 / Avoid use
Zoledronicacidb / <30 / Avoid use
Alendronate / < 35 / Avoid use
Ibandronic acid / 30–50 / Oral: 50 every second day, IV: 4 every 4 weeks
<30 / Oral:50 once each week, IV:2 every 4 weeks
<10 / Avoid use
Risedronate / <30 / Avoid use
Clodronate / 50–80 / 1600 daily
30–50 / 1200 daily
10–30 / 800 daily
<10 / Avoid use
Tiludronate / <30 / Avoid use
Strontium / <30 / Avoid use
Teriparatide / <30 / Avoid use
Duloxetine / <30 / 30 once daily
Bupropion / ≤ 50 / 150 once daily
Rivaroxaban / <15 / Avoid use
Dabigatran / 30-50 / 110 twice daily
<30 / Avoid use
Pregabalin / 30–60 / 300 in 1 or 2 doses
15–30 / 150 in 1 or 2 doses.
<15 / 75 as single dose.
Gabapentin / 50–79 / 600–1800 daily in 3 doses
30–49 / 300–900 daily in 2/3 doses.
15–29 / 600 daily in 2/3 doses.
<15 / 300 daily
Levetiracetam / 50–79 / 500–1000 twice daily
30–49 / 250–750 twice daily
<30 / 250-500 twice daily
Memantine / 5–29 / 10 once daily
Methysergide / <50 / Avoid use
Paliperidone / 50–80 / 6 once daily
30–50 / 3 once daily/Avoid injection
10-30 / 3 once daily
<10 / Avoid use
Pramipexole / 20–50 / 2.25 once daily
<20 / 1.5 once daily
Varenicline / <30 / 1 daily
Solifenacin / <30 / 5 once daily
Tolterodine / <30 / 1 twice daily

aAll recommendations are based on the Australian Medicines Handbook[24]bIndication for osteoporosis

Electronic Supplementary Material Table S1. Extent of inappropriate prescribing for each drug

Drugs / Number of Patients
Total / NR / HD / CI / A
Alendronate / 543 / 454 (83.6) / - / 89 (16.3) / -
Clodronate / 2 / - / - / - / 2 (100)
Risedronate / 457 / 412 (90.2) / - / 45 (9.8) / -
Zoledronic acid / 130 / 124 (95.3) / - / 6 (4.6) / -
Ibandronic acid / 1 / - / - / - / 1 (100)
Strontium / 160 / 139 (86.8) / - / 21 (13.2) / -
Teriparatide / 4 / 4 (100) / - / - / -
Perindopril / 1387 / 600 (43.2) / 612 (44.1) / - / 175 (12.6)
Olmesartan / 71 / 66 (92.9) / - / 5 (7.0) / -
Valsartan / 78 / 75 (96.1) / 2 (2.6) / - / 1 (1.2)
Fenofibrate / 205 / 85 (41.4) / 85 (41.5) / 1 (0.4) / 34 (16.5)
Metformin / 1514 / 203 (13.4) / 272 (17.8) / 54 (3.5) / 985 (65.0)
Glibenclamide / 29 / 20 (68.9) / - / 9 (31) / -
Sitagliptin / 183 / 127 (69.3) / 41 (22.5) / - / 15 (8.2)
Saxagliptin / 15 / 11 (73.3) / 4 (26.7) / - / -
Vildagliptin / 51 / 36 (70.5) / 11 (21.5) / - / 4 (7.8)
Rivaroxaban / 1 / 1 (100) / - / - / -
Dabigatran / 102 / 77 (75.4) / 1 (0.9) / 24 (23.5)
Duloxetine / 113 / 103 (91.1) / 6 (5.3) / - / 4 (3.5)
Pregabalin / 139 / 56 (40.2) / 5 (3.5) / - / 78 (56.1)
Gabapentin / 128 / 28 (21.8) / 14 (10.9) / - / 86 (67.1)
Levetiracetam / 30 / 10 (33.3) / 6 (20) / - / 14 (46.6)
Memantine / 13 / 11 (84.6) / 2 (15.3) / - / -
Paliperidone / 3 / 1 (33.3) / - / - / 2 (66.7)
Pramipexole / 99 / 68 (68.6) / - / - / 31 (31.3)
Varenicline / 14 / 14 (100) / - / - / -
Solifenacin / 84 / 81 (96.4) / - / - / 3 (3.6)
Tolterodine / 6 / 6 (100) / - / - / -
NR:Dose adjustment not required based on renal function, HD: Inappropriately high dose, CI:Contraindicated, A:Appropriate dose, “-“:Not applicable

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Electronic Supplementary Material Table S2. Extent of inappropriate prescribing for individual drug:comparision of HMR and RMMR

Drugs / Number of HMR Patients / Number of RMMR Patients
Total / NR / HD / CI / A / Total / NR / HD / CI / A
Alendronate / 431 / 372 (86.3) / - / 59 (13.7) / - / 112 / 82 (73.2) / - / 30 (26.7) / -
Clodronate / 1 / - / - / - / 1 (100) / - / - / - / 1 (100)
Risedronate / 382 / 351 (91.9) / - / 31 (8.1) / - / 75 / 61 (81.3) / - / 14 (18.6) / -
Zolendronic acid / 119 / 113 (94.9) / - / 6 (5) / - / 11 / 11 (100) / - / - / -
Ibandronic acid / 1 / - / - / - / 1 (100) / - / - / - / - / -
Strontium / 127 / 116 (91.3) / - / 11 (8.7) / - / 33 / 23 (69.6) / - / 10 (30.3) / -
Teriparatide / 2 / 2 (100) / - / - / - / 2 / 2 (100) / - / - / -
Perindopril / 1089 / 538 (49.4) / 450 (41.3) / - / 101 (9.2) / 298 / 62 (20.8) / 162 (54.3) / - / 74 (24.8)
Olmesartan / 69 / 66 (95.6) / - / 3 (4.3) / - / 2 / - / - / 2 (100) / -
Valsartan / 76 / 73 (96) / 2 (2.6) / - / 1 (1.3) / 2 / 2 (100) / - / - / -
Fenofibrate / 189 / 82 (43.3) / 75 (39.7) / 1 (0.52) / 31 (16.4) / 16 / 3 (18.7) / 10 (62.5) / - / 3 (18.7)
Metformin / 1326 / 184 (13.8) / 241 (18.1) / 32 (2.4) / 895 (67.5) / 188 / 19 (10.1) / 31 (16.4) / 22 (11.7) / 117 (62.2)
Glibenclamide / 27 / 19 (70.3) / - / 8 (29.6) / - / 2 / 1 (50) / - / 1 (50) / -
Sitagliptin / 168 / 126 (75) / 32 (19) / - / 10 (6) / 15 / 1 (6.6) / 9 (60) / - / 5 (33.3)
Saxagliptin / 13 / 10 (76.9) / 3 (23.1) / - / - / 2 / 1 (50) / 1 (50) / - / -
Vildagliptin / 48 / 34 (70.8) / 10 (20.8) / - / 4 (8.3) / 3 / 2 (66.6) / 1 (33.3) / - / -
Rivaroxaban / 1 / 1 (100) / - / - / - / - / - / - / - / -
Dabigatran / 93 / 70 (75.3) / - / 1 (1.07) / 22 (23.6) / 9 / 7 (77.7) / - / - / 2 (22.2)
Drugs / Number of HMR Patients / Number of RMMR Patients
Total / NR / HD / CI / A / Total / NR / HD / CI / A
Duloxetine / 87 / 82 (94.2) / 4 (4.6) / - / 1 (1.1) / 26 / 21 (80.7) / 2 (7.6) / - / 3 (11.5)
Pregabalin / 125 / 50 (40) / 5 (4) / - / 70 (56) / 14 / 6 (42.8) / - / - / 8 (57.1)
Gabapentin / 96 / 24 (25) / 10 (10.4) / - / 62 (64.6) / 32 / 4 (12.5) / 4 (12.5) / - / 24 (75)
Levetiracetam / 22 / 6 / 5 / - / 11 (50) / 8 / 4 (50) / 1 / - / 3 (37.5)
Memantine / 6 / 5 (83.3) / 1 (16.6) / - / - / 7 / 7 (100) / - / - / -
Paliperidone / 1 / - / - / - / 1 (100) / 2 / 1 (50) / - / - / 1 (50)
Pramipexole / 73 / 54 (74) / - / - / 19 (26) / 26 / 14 (53.8) / - / - / 12 (46.1)
Varenicline / 13 / 13 (100) / - / - / - / 1 / 1 (100) / - / - / -
Solifenacin / 77 / 74 (96.1) / - / - / 3 (3.9) / 7 / 7 (100) / - / - / -
Tolterodine / 6 / 6 (100) / - / - / - / - / - / - / - / -
NR:Dose adjustment not required based on renal function, HD: Inappropriately high dose, CI:Contraindicated, A:Appropriate dose, “-“: Not applicable

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Electronic Supplementary Material Table S3. Top most inappropriately prescribed drugs in the study sample: A comparison of HMR and RMMR

Category / HMR % / RMMR %
Top five drugs prescribed most inappropriatelywith high dose / Perindopril (41.3)
Fenofibrate (39.7)
Saxagliptin (23.1)
Vildagliptin (20.8)
Sitagliptin (19) / Fenofibrate (62.5)
Sitagliptin (60)
Perindopril (54.3)
Saxagliptin (50)
Vildagliptin (33.3)
Top five drugs prescribed most inappropriately in a contraindicated condition / Glibenclamide (29.6)
Alendronate (13.7)
Strontium (8.7)
Risedronate (8.1)
Zolendronic acid (5) / Glibenclamide (50)
Strontium (30.3)
Alendronate (26.7)
Risedronate (18.6)
Metformin (11.7)
Total inappropriateness
High dose+ contraindicated / Perindopril (41.3)
Fenofibrate (40.2)
Glibenclamide (29.6)
Saxagliptin (23.1)
Vildagliptin (20.8)
Metformin (20.5)
Sitagliptin (19) / Fenofibrate (62.5)
Sitagliptin (60)
Perindopril (54.3)
Saxagliptin (50)
Glibenclamide (50)
Vildagliptin (33.3)
Strontium (30.3)
Metformin (28.1)
HMR- Home medicines review, RMMR- Residential medication management review

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