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Pharmacokinetics of opioids in renal dysfunction
G Davies1, C Kingswood, M Street
1University of Brighton, England.
Clinical Pharmacokinetics
|December 1, 1996
Summary
Opioid analgesics require careful use in patients with renal insufficiency due to metabolite accumulation. Morphine metabolites can accumulate, while pethidine and dextropropoxyphene metabolites pose toxicity risks, necessitating cautious prescribing.
Area of Science:
- Pharmacology
- Nephrology
- Pain Management
Background:
- Patients with renal insufficiency often need opioid analgesics for pain.
- Metabolite accumulation of certain opioids complicates their use in impaired renal function.
Purpose of the Study:
- To review the handling of common opioid analgesics in patients with renal insufficiency.
- To highlight potential risks associated with opioid metabolite accumulation in renal failure.
Main Methods:
- Literature review of pharmacokinetic data for various opioid analgesics.
- Analysis of case reports regarding opioid use in renal insufficiency.
Main Results:
- Morphine metabolites (morphine-6-glucuronide, morphine-3-glucuronide) accumulate in renal failure.
- Pethidine and dextropropoxyphene metabolites (norpethidine, norpropoxyphene) have increased half-lives, posing toxicity risks.
- Codeine, dihydrocodeine, and continuous fentanyl administration may cause prolonged effects in renal insufficiency.
Conclusions:
- Routine use of pethidine and dextropropoxyphene is ill-advised in renal insufficiency.
- Careful consideration and monitoring are required when prescribing codeine, dihydrocodeine, and fentanyl to patients with impaired renal function.
- While morphine itself is less affected, its metabolites' accumulation warrants attention.