In CrCl ≤ 80 mL/min, which drug requires dose reduction due to CNS adverse effects?

• A. Gabapentin
• B. Levetiracetam
• C. Tramadol
• D. Pregabalin

Answer: (B)

When kidney function drops, drugs that are cleared mainly by the kidneys can build up in the body, raising the risk of central nervous system side effects such as sedation, dizziness, confusion, or agitation. Levetiracetam is almost completely eliminated by the kidneys with minimal hepatic metabolism, so its exposure increases noticeably as creatinine clearance falls. In practice, guidelines used with the Beers Criteria recommend a dose reduction for levetiracetam when CrCl is at or below 80 mL/min to prevent those CNS adverse effects.

Other options are also renally cleared and can require adjustments in renal impairment, but the dosing guidance most emblematic of a reduction starting at CrCl of 80 mL/min is associated with levetiracetam, reflecting its sensitivity to decreased renal clearance and CNS-related risks.