Edoxaban should be avoided if CrCl is below 15 or above 95 mL/min. Which statement is true?

• A. Avoid if CrCl <15 or >95
• B. Reduce dose 15-50
• C. No adjustment unless indicated
• D. Increase dose if CrCl >95

Answer: (A)

In older adults, how a drug is cleared by the kidneys changes both safety and efficacy. Edoxaban is partly eliminated by the kidneys, so very low kidney function can cause drug buildup and bleeding risk, while very high kidney function can lead to faster clearance and reduced anticoagulant effect, increasing stroke risk. The Beers Criteria flags these extremes and advises avoiding edoxaban when CrCl is less than 15 mL/min or greater than 95 mL/min. Therefore, avoiding the drug at CrCl <15 or >95 mL/min is the correct stance. If CrCl falls in mid-range (for example 15–50 mL/min), dose adjustments may be considered under specific conditions, but that doesn’t apply to these extreme values, and increasing the dose would not be appropriate.