Table 2.

Analgesics used in cases of hepatic and/or renal insufficiency [104]

Drug name	Severe hepatic insufficiency	Renal insufficiency (glomerular filtration rate <30 ml/min)
NSAID, coxibs	Contraindicated	Contraindicated
Paracetamol	Is metabolised by enzymes in the liver into hepatotoxic N‑acetyl-p-benzoquinone imine and therefore contraindicated in case of liver damage	Longer intervals of 8–12 h
Dipyrone	No dosage adjustment	Dosage reduction
Duloxetine	Contraindicated	Contraindicated
Venlafaxine	50% dosage reduction	50% dosage reduction
Amitriptyline	CAUTION increased spasticity, dosage adjustment necessary	Dosage adjustment because of increased risk of urine retention
Gabapentin	No dosage adjustment	150–600 mg (divided into 3 daily doses)
Pregabalin	No dosage adjustment	25–150 mg (divided into 2 daily doses)
Tramadol	Longer dosage interval of 12 h necessary, maximum daily dose: 200 mg	Longer dosage interval of 12 h, maximum daily dose: 200 mg
Oxycodone	50% dosage reduction	50% dosage reduction
Hydromorphone	No dosage adjustment	No dosage adjustment
Fentanyl	No dosage adjustment	25% dosage reduction
Morphine	Longer dosage interval	25–50% dosage reduction
Buprenorphine	Possible dosage reduction	No dosage adjustment

NSAID nonsteroidal anti-inflammatory drugs