Opioids in patients with renal impairment

Renal impairment can reduce the elimination of certain opioids and their metabolites. Accumulation and toxicity may occur. Due to their pharmacokinetic properties, fentanyl, alfentanil and buprenorphine can be used safely in patients with renal impairment. Codeine and pethidine should be avoided entirely. Morphine should also be avoided if the creatinine clearance is below 30 ml / min. Reduced dose hydromorphone is an alternative here. Methadone, oxycodone and tramadol should be used with caution and in reduced doses. In this article we briefly explain the renal elimination processes, certain pharmacokinetic properties of the different opioids and the recommendations for clinical practice.