Pfefferkorn Florian, Harings-Kaim Annette, Schönenberger Melanie, Leuppi-Taegtmeyer Anne
Abteilung Klinische Pharmakologie und Toxikologie, Universitätsspital Basel.
Abteilung Transplantationsimmunologie und Nephrologie, Universitätsspital Basel.
Ther Umsch. 2020;77(1):10-13. doi: 10.1024/0040-5930/a001144.
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.
肾功能损害患者使用阿片类药物 肾功能损害会降低某些阿片类药物及其代谢产物的清除率。可能会发生蓄积和毒性反应。由于其药代动力学特性，芬太尼、阿芬太尼和丁丙诺啡可在肾功能损害患者中安全使用。应完全避免使用可待因和哌替啶。如果肌酐清除率低于30 ml/min，也应避免使用吗啡。在此情况下，可选用剂量减半的氢吗啡酮。美沙酮、羟考酮和曲马多应谨慎使用且剂量减半。在本文中，我们简要解释了肾脏清除过程、不同阿片类药物的某些药代动力学特性以及临床实践建议。
