Page 464 Acute Pain Management

Drug Comments Recommendations References
NB doses must still be
titrated to effect for each
patient
Buprenorphine Pharmacokinetics unchanged; No dose adjustment Boger, 2006
predominantly biliary excretion required Davies et al, 1996
of metabolites Filitz et al, 2006
Pharmacokinetics also unchanged Hand et al, 1990
with dialysis Launay‐Vacher et
al, 2005
Mercadante &
Arcuri, 2004
Codeine Accumulation of active Dose adjustment AMH, 2008
metabolites can occur; prolonged recommended or use an Craig & Hunter,
sedation and respiratory arrest alternative opioid 2008
have been reported in patients Davies et al, 1996
with renal impairment Dean, 2004
No good data on removal by Mercadante &
dialysis Arcuri, 2004
Dextro‐ Accumulation of active Use of alternative agent AMH, 2008
propoxyphene metabolite recommended Launay‐Vacher et
(nordextropropoxyphene) can al, 2005
lead to CNS and cardiovascular Mercadante &
system toxicity Arcuri, 2004
Blood concentrations not Murtagh et al,
significantly changed during 2007
dialysis
Dihydrocodeine Metabolic pathway probably Insufficient evidence: use Craig & Hunter,
similar to codeine not recommended 2008
Davies et al, 1996
Murtagh et al,
2007
Fentanyl No active metabolites No dose adjustment AMH, 2008
Not removed to any significant required; may be used in Craig & Hunter,
degree by dialysis patients with severe renal 2008
impairment Dean, 2004
CHAPTER 11 al, 2005
Launay‐Vacher et
Mercadante &
Arcuri, 2004
Murtagh et al,
2007
Hydromorphone Neurotoxicity from accumulation
recommended or use
of H3G possible Dose adjustment AMH, 2008
Davison & Mayo,
H3G is effectively removed alternative opioid 2008
during dialysis Dean, 2004
Mercadante &
Arcuri, 2004

416 Acute Pain Management: Scientific Evidence