Which drug is primarily eliminated by the liver?

• A. Repaglinide
• B. Metformin
• C. Exenatide
• D. Linagliptin

Answer: (A)

When a drug is cleared from the body, its main route of elimination can be hepatic (liver) or renal (kidneys). For this question, the key idea is which drug relies mainly on the liver to remove it from the body.

Repaglinide is cleared predominantly by the liver. It undergoes extensive hepatic metabolism, mainly by cytochrome P450 enzymes, and its metabolites are excreted in bile. This hepatic pathway is the primary route of elimination for this drug, making liver elimination its defining characteristic among the options.

Metformin, in contrast, is eliminated largely unchanged by the kidneys, so renal clearance is its main route. Exenatide is cleared mainly through proteolytic degradation with renal excretion. Linagliptin is eliminated via hepatobiliary routes with little renal excretion, but the classic standout for primary liver elimination in typical pharmacokinetic profiles is repaglinide.