Which of the following drugs is included in the CrCl CI drugs for patients with a clearance of less than 30?

• A. Tadalafil
• B. Ibuprofen
• C. Metformin
• D. Warfarin

Answer: (A)

Tadalafil is correct because it is contraindicated in patients with a creatinine clearance (CrCl) of less than 30 mL/min due to the risk of accumulation and increased risk of side effects, particularly hypotension and priapism. In conditions of impaired renal function, the metabolism and excretion of tadalafil can be significantly altered, leading to prolonged drug exposure.

In contrast, other drugs on the list do not share this same stringent contraindication with regards to renal clearance. Metformin, for example, is also contraindicated in patients with CrCl below 30 mL/min but is more typically highlighted in discussions about renal toxicity and lactic acidosis. Warfarin does not have a specific CrCl threshold below which it is contraindicated, although renal function should be monitored as it plays a role in the metabolism of the drug. Ibuprofen, while it can cause renal impairment, does not have a specific contraindication based solely on CrCl below 30 mL/min, although caution is warranted.