In CrCl less than 50 mL/min, what adjustment is recommended for famotidine?

• A. Reduce dose
• B. No adjustment
• C. Increase dose
• D. Stop therapy

Answer: (A)

In renal impairment, drugs cleared by the kidneys can accumulate. Famotidine is primarily eliminated renally, so when CrCl falls below 50 mL/min, the drug stays in the body longer, raising exposure and the risk of adverse effects like delirium or confusion in older adults. To prevent this, the dose should be reduced (or the dosing interval extended) so that the total amount of drug the body is exposed to remains safer while still providing symptom relief. Stopping therapy isn’t typically necessary unless there are specific contraindications, and increasing the dose would worsen accumulation.