| Drug/Class | Hepatic Impairment (HI) Adjustment | Renal Impairment (RI) Adjustment |
|---|---|---|
| ‣ | No adjustment needed | No adjustment needed |
| Vortioxetine | No adjustment needed for mild to moderate HI. Use not recommended in severe HI | No adjustment needed |
| Desvenlafaxine | No adjustment needed (max dose of 100 mg in moderate to severe HI) | Mild RI: no adjustment needed |
| Moderate RI: max 50 mg/d | ||
| Severe RI: max 25 mg/d or 50 mg every other day | ||
| Levomilnacipran | No adjustment needed | Moderate RI: max 80 mg/d; Severe RI: max 40 mg/d |
| ‣ | No adjustment needed | Moderate RI: 50–75% dose reduction |
Dialysis: supplement 300 mg after each dialysis session (lithium is dialyzable) | | ‣ | Reduce dose by 50% | Mild RI: no adjustment; Moderate RI: 50% reduction; Severe RI: 75% reduction | | ‣ | Reduce dose by 50% | Mild to moderate RI: reduce by 25–50% Severe RI: reduce by 50–75% | | ‣ | Cautious dosing; no explicit dosing guidelines | Moderate RI: decrease by 30%; Severe RI: decrease by 50% | | ‣ | Moderate to severe HI: do not exceed 75 mg/d for IR, 100 mg/d for SR or 150 mg every other day for XL | Consider reducing initial dose; may accumulate in ESRD | | Brexpiprazole | Moderate to severe HI: max dose 2 mg/d | Moderate to severe RI: max dose 2 mg/d | | ‣ | Lower initial dose and slower titration | Lower initial dose and slower titration | | ‣ | Use with great caution in moderate/severe HI | Use with caution; reduced starting dose and titration | | ‣ | In severe HI, reduce starting dose and titration | Reduce starting dose by 50%; decrease titration rate | | Paliperidone | Mild to moderate HI: no adjustment needed Severe HI: limited data | Mild RI: max 6 mg/d; Moderate RI: max 3 mg/d; Severe RI: contraindicated | | ‣ | Reduce dose by 50% in moderate HI and 75% in severe HI | Use with caution; reduced dose and titration in RI | | ‣ | Contraindicated in HI | No adjustment needed for RI; not recommended with ESRD/dialysis | | | Contraindicated in HI | Reduced/cautious in mild RI; Contraindicated in severe RI | | Nefazodone | Contraindicated in HI (risk of liver failure) | No adjustment in mild/moderate RI; Contraindicated in severe RI | | ‣ | Potentially serious hepatic effects; no guidelines | Use with caution; no explicit recommendations | | ‣ | Cautious dosing; no guidelines | Cautious dosing; no guidelines | | Modafinil | Reduce by 50% in severe HI | Limited data; no recommendations | | ‣ | Limited data; no recommendations | Limited data; no recommendations |