Kidneys are sensitive to damage by drugs, with up to 20% of episodes of drug-induced acute renal failure. New prescribers must be able to identify these patients and eliminate these risks when possible; avoid potentially nephrotoxic drugs; and adjust drug doses in patients, where necessary, in those with pre-existing renal impairment to avoid drug accumulation and toxicity. This chapter identifies high-risk drug classes to avoid in renal failure, top tips to avoid drug toxicity, how to treat patients in chronic renal failure and provides a quick reference guide for drug dose reduction in those with renal impairment.