Prescribing opioids in renal failure

Joanne Droney, MB, BCh, MRCP(I); Jeremy Levy, PhD, FRCP; Columba Quigley, FRCP

doi:10.5055/jom.2007.0019

Authors

Joanne Droney, MB, BCh, MRCP(I)
Jeremy Levy, PhD, FRCP
Columba Quigley, FRCP

DOI:

https://doi.org/10.5055/jom.2007.0019

Keywords:

renal impairment, opioid, morphine, glomerular filtration rate, creatinine

Abstract

Opioids are commonly used in both cancer and noncancer pain. Many patients who require opioids have renal impairment. This can adversely influence the safety of opioids in these patients.
Objectives: The objectives of this study were to (1) determine which opioids are most commonly prescribed in patients with renal impairment, (2) to identify differences in prescribing practices between two groups of physicians, and (3) to determine how renal impairment was recognized in this setting.
Design and participants: A questionnaire postal survey was sent out to renal and palliative medicine consultants in UK and Ireland. One hundred and seventyeight (30.5 percent) questionnaires were completed.
Results: A larger proportion of renal than palliative medicine physicians prescribed morphine in patients with renal impairment. A significant number of physicians did not adjust doses of morphine or codeine. Palliative medicine physicians were more likely to prescribe opioids other than morphine, with the exception of fentanyl which was widely used by both groups. Renal physicians were more likely to base their choice of opioid on glomerular filtration rate while palliative medicine physicians were more likely to be influenced by serum creatinine.
Conclusions: Consensus guidelines drawing on expertise from both palliative and renal physicians are needed to promote safer use of opioids in this vulnerable patient group.

Author Biographies

Joanne Droney, MB, BCh, MRCP(I)

Specialist Registrar Palliative Medicine, Royal Marsden Hospital, London.

Jeremy Levy, PhD, FRCP

Consultant Nephrologist, West London Renal and Transplant Centre, Hammersmith Hospitals NHS Trust, London.

Columba Quigley, FRCP

Consultant Palliative Medicine, Hammersmith Hospital NHS Trust, London.

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