Hematology Unit, S. Eugenio Hospital, Piazzale dell'Umanesimo 10, 00144, Rome.
Curr Drug Targets. 2010 Jun;11(6):752-8. doi: 10.2174/138945010791170879.
Pain in patients with impaired renal function may be a significant problem requiring treatment with opioids. However, pharmacokinetic and metabolic changes associated with an impaired renal function may raise some concerns about side effects and overdosing associated with opioid agents in this patient's population. In order to give recommendations on this issue, we review the available evidences on the pharmacokinetics and side effects of most common opioids used to treat pain. The results of this review show that the half-life of the parent opioid compounds and of their metabolites is increased in the presence of renal dysfunction, for which careful monitoring of the patient, dose reduction and a longer time interval between doses are recommended. Among opioids, morphine and codeine used with very caution and possibly avoided in renal failure/dialysis patients; tramadol, hydromorphone and oxycodone can be used with caution and close patient's monitoring, whereas transdermal buprenorphine, methadone and fentanyl/sufentanil appear to be safe to use in patients with renal failure.
肾功能受损患者的疼痛可能是一个需要用阿片类药物治疗的重大问题。然而，与肾功能受损相关的药代动力学和代谢变化可能会引起人们对该患者人群中阿片类药物相关副作用和过量的一些担忧。为了对此问题提出建议，我们回顾了最常用于治疗疼痛的常见阿片类药物的药代动力学和副作用的现有证据。这一综述的结果表明，在肾功能不全的情况下，母体阿片类化合物及其代谢物的半衰期延长，因此建议对此类患者进行仔细监测、剂量减少以及增加给药间隔时间。在阿片类药物中，吗啡和可待因在肾功能衰竭/透析患者中应谨慎使用，甚至可能避免使用；曲马多、氢吗啡酮和羟考酮可谨慎使用，并密切监测患者；而经皮丁丙诺啡、美沙酮和芬太尼/舒芬太尼似乎可安全用于肾功能衰竭患者。
