Pharmacokinetics of opioids in renal dysfunction

Graham Davies, Christopher Kingswood, Martin Street

    Research output: Contribution to journalLiterature reviewpeer-review

    Abstract

    Patients with renal insufficiency commonly require the administration of an opioid analgesic to provide adequate pain relief. The handling of morphine, pethidine (meperidine) and dextropropoxyphene in patients with renal insufficiency is complicated by the potential accumulation of metabolites. While morphine itself remains largely unaffected by renal failure, accumulation, as denoted by an increase in both mean peak concentrations and the area under the concentration-time curve, of both the active metabolite (morphine-6-glucuronide) and the principal metabolite (morphine-3-glucuronide, thought to possess opiate antagonist properties) have been reported. The increased elimination half-lives of the toxic metabolites norpethidine and norpropoxyphene in patients with poor renal function administered pethidine and dextropropoxyphene, respectively, makes their routine use ill advised. Case reports of prolonged narcosis associated with the use of both codeine and dihydrocodeine in patients with renal insufficiency call for care to be used when prescribing these agents under such conditions. Although the pharmacokinetics of buprenorphine, alfentanil, sufentanil and remifentanil change little in patients with renal failure, the continuous administration of fentanyl can lead to prolonged sedation.

    Original languageEnglish
    Pages (from-to)410-422
    Number of pages13
    JournalClinical Pharmacokinetics
    Volume31
    Issue number6
    DOIs
    Publication statusPublished - 1996

    Fingerprint

    Dive into the research topics of 'Pharmacokinetics of opioids in renal dysfunction'. Together they form a unique fingerprint.

    Cite this