Table 4.
Effects of analgesic drugs in patients with renal failure. eGFR: glomerular filtrate rate.
| Drug | Kidney Excretion | Effects in Patients with Renal Failure |
|---|---|---|
| Acetaminophen | 90–99% [102] | Not used with eGFR of <10 mL/min [63,100]. |
| Oxycodone | 50% | Dose adjustments [73]. Some authors consider oxycodone unsafe in patients with advanced kidney failure due to its accumulation risk, interactions, and CYP450 polymorphisms [100]. |
| Buprenorphine | 10–30 [103] | Caution with eGFR of <30 mL/min [70]. |
| Fentanyl | 10% or less of active compound and 75% of the total dose. Metabolites are excreted mainly in urine [74]. | Dose monitoring [74]. |
| Methadone | 20–50% as methadone or its metabolites [101] | Contraindicated in patients with severe kidney impairment [66]. Lower doses and longer intervals between administration in patients with kidney impairment [104]. |
| Morphine | 70–80% [105] | eGFR of 10–50 mL/min: dose reduction of 25%; eGFR of <10 mL/min: dose reduction of 50% [104]. One of the worst options in advanced kidney failure due to accumulation risk [100]. |
| Codeine | Mainly excreted in kidneys [106] | Caution is needed. Davison et al. consider codeine one of the worst options in patients with advanced kidney failure due to CYP2D6 polymorphisms and accumulation risk [100]. |
| Hydromorphone | Most of the dose; 7% unmodified drug [107] | Dose reduction [108]. |
| Hydrocodone | Eliminated with its metabolites, mainly in kidneys, percentage not available [71] | Caution/dose reduction [71,77]. Davison considers it one of the worst options in patients with advanced kidney failure, according to CYP2D6 polymorphism-related and variable responses and possible accumulation risk [100]. |
| Tapentadol | 99% [75] | Not recommended in patients with severe insufficiency [75]. |
| Tramadol | 90% [72] | Prolonged interval between doses; do not use long-release formulation [72]. Increase the interval of administration to 12 h, and limit maximum daily dose to 200 mg [109]. |
| Duloxetine | 70% [110] | eGFR of <30 mL/min: do not use [41]. |
| Amitriptyline | 95% [31] | No dose reduction [31,100,111]. |
| 5% lidocaine patch | >85% | eGFR of <30 mL/min (severe kidney impairment): caution [112]. |
| Tizanidine | 60–70% [46] | eGFR of <25 mL/min: start with 2 mg/day [46]. |
| Baclofen | 75% [44] | Start with lower dosages in all patients with mild–moderate kidney impairment, and use only if benefit outweighs the risk in those with severe kidney impairment [44]. |
| Thiocolchicoside | 20% [48] | No dose adjustments [48]. |
| Cyclobenzaprine | 80% | Low dosage [45]. |
| Eperisone | 76.6% [47] | eGFR of <25 mL/min: low dosage, max. 150 mg daily [47]. |
| Pregabalin | 99% | eGFR of 30–59 mL/min: 300 mg/daily. eGFR of 15–29 mL/min: 150 mg/daily. eGFR of <15 mL/min: 75 mg/daily [113]. |
| Gabapentin | 99% | eGFR of 30–59 mL/min: 1400 mg/daily. eGFR of 15–29 mL/min: 700 mg/daily. eGFR of <15 mL/min: 300 mg/daily [113]. |