In a client with acute renal failure, which drug would not require adjustment of dosage or dosing schedule?

• A. Acetaminophen (Tylenol)
• B. Gentamicin sulfate (Garamycin)
• C. Cyclosporine (Sandimmune)
• D. Ticarcillin disodium (Ticar)

Answer: (A)

In acute renal failure, the main issue is how a drug is cleared from the body. When the kidneys aren’t functioning well, drugs that rely on renal excretion or have a narrow therapeutic window need dose or interval adjustments to avoid buildup and toxicity. Acetaminophen is primarily processed by the liver, with only a small portion how it’s excreted by the kidneys. Because renal failure doesn’t significantly affect its clearance, its dosing usually doesn’t require adjustment, making it the best choice in this scenario. The other drugs depend more on the kidneys for elimination or carry nephrotoxicity risks, so their dosing is typically altered in acute renal failure to prevent accumulation and adverse effects.