Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 31 (6), 410-22

Pharmacokinetics of Opioids in Renal Dysfunction


Pharmacokinetics of Opioids in Renal Dysfunction

G Davies et al. Clin Pharmacokinet.


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.

Similar articles

See all similar articles

Cited by 28 PubMed Central articles

See all "Cited by" articles


    1. Br J Anaesth. 1982 Aug;54(8):871-7 - PubMed
    1. Anesth Analg. 1988 Mar;67(3):268-71 - PubMed
    1. Clin Pharmacol Ther. 1984 May;35(5):641-5 - PubMed
    1. Clin Toxicol. 1979 Oct;15(3):267-71 - PubMed
    1. Anesthesiology. 1984 Nov;61(5):502-6 - PubMed


LinkOut - more resources