In CrCl less than 30 mL/min, what is the recommended action for probenecid?

• A. Avoid
• B. Reduce dose
• C. Monitor for AEs
• D. No adjustment

Answer: (A)

In severe renal impairment (CrCl < 30 mL/min), probenecid should be avoided. Probenecid is a uricosuric that relies on increasing renal excretion, and it also inhibits proximal tubular transporters that affect the clearance of other drugs, such as penicillins. When kidney function is this reduced, clearance drops substantially and the drug can accumulate, raising the risk of adverse effects and drug interactions. The Beers Criteria flag this combination to prevent harm in older adults, making avoidance the safest and most appropriate course. Reducing the dose wouldn’t reliably prevent accumulation, monitoring for adverse events wouldn’t mitigate the underlying risk, and not adjusting therapy would leave the patient exposed to potential toxicity.