Page 467 Acute Pain Management

Drug Comments Recommendations References
NB doses must still be
titrated to effect for each
patient
NsNSAIDs and Can affect renal function Use with caution in Launay‐Vacher et
coxibs Behaviour during dialysis not patients with mild renal al, 2005
clearly elucidated for most impairment and avoid in
patients with severe renal
impairment
Clonidine Half‐life is increased in severe Limited data; dose Khan et al, 1999
renal failure adjustment has been Lowenthal et al,
50% metabolised by the liver; recommended 1993
remained excreted unchanged by
the kidney
Tricyclic Amitriptyline is metabolised in Limited data; metabolite Lieberman et al,
antidepressants the liver to nortriptyline, the accumulation may occur 1985
active agent and increase the risk of Murphy, 2005
Not significantly removed by side effects but little Dargan et al, 2005
dialysis evidence to indicate need
for dose reduction
Ketamine Dehydronorketamine levels are Limited data; probable Koppel et al, 1990
increased but it has only 1% of that no dose adjustment
potency of ketamine is required
Ketamine is not removed well by
dialysis
Gabapentinoids Gabapentin: impaired renal Dose adjustment AMH, 2008
function results in reduced recommended on basis of Blum et al, 1994
clearance in direct proportion to creatinine clearance Wong et al, 1995
creatinine clearance; about 35%
cleared by dialysis
Pregabalin: Impaired renal Dose adjustment AMH, 2008
function results in reduced recommended on basis of Randinitis et al,
clearance in direct proportion to creatinine clearance 2003
creatinine clearance; highly
cleared by dialysis

Table 11.6 Analgesic drugs in patients with hepatic impairment CHAPTER 11
Drug Comments Recommendations References
NB doses must still be
titrated to effect for each
patient
Opioids
Alfentanil No significant difference in half‐ Limited data: no dose Davis et al, 1989
life found in children undergoing adjustment required
liver transplant
Buprenorphine Lower blood concentrations of Limited data: no dose Johnson et al,
buprenorphine and adjustment required 2005
norbuprenorphine

Acute pain management: scientific evidence 419