Morphine Use in Renal Failure: A Case Report of Single-Dose Morphine Toxicity in a Patient Requiring Peritoneal Dialysis

J Pharm Pract. 2020 Dec;33(6):903-906. doi: 10.1177/0897190019853992. Epub 2019 Jun 27.


Objective: We describe a case of morphine toxicity presumably caused by accumulation of its active metabolite morphine-6-glucuronide (M6G) secondary to reduced clearance by peritoneal dialysis.

Methods: We present the relevant history and laboratory data and review pertinent literature regarding the use of opioids in renal failure.

Results: A 76-year-old African-American female received one dose of morphine sulfate and developed signs and symptoms of morphine toxicity for 2 days, even after multiple peritoneal dialysis sessions.

Conclusion: Because of reduced renal clearance of morphine and its metabolites in patients requiring peritoneal dialysis, morphine should be avoided as an analgesic option in this population due to increased risk of morphine toxicity.

Keywords: M6G; hospice; morphine; morphine toxicity; peritoneal dialysis; renal clearance.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Analgesics, Opioid / adverse effects
  • Female
  • Humans
  • Morphine / adverse effects
  • Morphine Derivatives
  • Peritoneal Dialysis*
  • Renal Insufficiency* / chemically induced


  • Analgesics, Opioid
  • Morphine Derivatives
  • Morphine