Table 3.

Dialyzability of selected toxins by therapeutic class

Therapeutic Class/Group of PoisonsExamplesGeneral Pharmacokinetic PropertiesSelected Agents Amenable to Extracorporeal RemovalSelected Agents Not Amenable to Extracorporeal Removal
AntiarrhythmicsAmiodarone, flecainide, lidocaine, sotalolLipophilic with high volume of distribution, protein bindingSotalol (HD)Amiodarone, flecainide, lidocaine
Anti-diabetic medicationsInsulin, metformin, sulfonylureasVariedMetformin (HD)Insulin, sulfonylureas
Antidepressants and antipsychoticsAmitriptyline, haloperidol, quetiapine, sertralineLipophilic with high volume of distribution, protein bindingLithium (HD, CRRT)SSRIs/SNRIs, TCAs, antipsychotics
AntiepilepticsBarbiturates, benzodiazepines, carbamazepine, phenytoinVaried; generally at least moderately lipophilicBarbiturates (HD); after massive ingestion, carbamazepine, phenytoin, valproic acid (HD)Benzodiazepines, lamotrigine
AntimicrobialsAntifungals, antivirals, β-lactams, glycopeptidesVariedCefepime, vancomycin (HD)Amphotericin
β-Adrenergic receptor blockersAcebutolol, atenolol, carvedilol, labetalol, metoprololVariedAcebutolol, atenolol, metoprolol (HD)Most agents; carvedilol, propranolol, labetalol
Calcium channel blockersAmlodipine, diltiazem, nifedipine, verapamilLipophilic with high volume of distribution, protein bindingNoneAmlodipine, diltiazem, nifedipine, verapamil
Cardiac glycosidesDigoxin, plant toxins (e.g., oleandrin)Lipophilic with high volume of distribution, protein bindingNoneAll
Chemotherapeutic agentsCisplatin, methotrexate, rituximab, vincristine, doxorubicinVariedMethotrexate (HD), rituximab, cisplatin (plasma exchange)Vincristine, doxorubicin
MethylxanthinesCaffeine, theophyllineHydrophilic with low volume of distribution, low protein bindingAllNone
Oral anticoagulantsApixaban, dabigatran, rivaroxaban, warfarinMost lipophilic with high volume of distribution, protein bindingDabigatran (HD)Apixaban, rivaroxaban, warfarin
Sympathomimetic agentsCocaine, amphetamines, synthetic cathinones (“bath salts”)Lipophilic with high volume of distribution, protein bindingNoneCocaine, amphetamines, synthetic cathinones
  • HD, hemodialysis; CRRT, continuous renal replacement therapy; SSRIs, selective serotonin reuptake inhibitors; SNRIs, serotonin-norepinephrine reuptake inhibitors; TCAs, tricyclic antidepressants.