Which medication commonly requires dosage adjustment in renal impairment?

The correct choice, Digoxin, is a medication that requires careful dosage adjustment in patients with renal impairment due to its narrow therapeutic index and renal excretion. Digoxin is primarily eliminated by the kidneys, so any decline in renal function can lead to increased serum levels of the drug, enhancing the risk of toxicity. Therefore, it is crucial to monitor renal function (typically through serum creatinine or estimated glomerular filtration rate) and adjust the dosages accordingly to prevent adverse effects, especially since digoxin can have significant effects on the heart.

In comparison, while the other listed medications may have considerations in patients with renal impairment, they do not require the same level of dosage adjustment specificity as digoxin. Ibuprofen is an NSAID that can affect renal function but does not have the same critical need for adjustment based solely on renal impairment. Amoxicillin, an antibiotic, also requires some adjustments but is generally safer and can be used at differing doses depending on severity rather than strict adjustments based on kidney function. Metformin is contraindicated in severe renal impairment due to the risk of lactic acidosis, but it may not require dosage adjustments in mild to moderate impairment as strictly as digoxin. Therefore, digoxin stands out as the medication that significantly hinges