Chapter

Acute pain in patients with renal or hepatic impairment

Ramini Moonesinghe and Sue Mallett

in Acute Pain

Published on behalf of Oxford University Press

Published in print June 2010 | ISBN: 9780199234721
Published online May 2011 | e-ISBN: 9780191739972 | DOI: http://dx.doi.org/10.1093/med/9780199234721.003.0015

Series: Oxford Pain Management Library

Acute pain in patients with renal or hepatic impairment

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The metabolism and excretion of many analgesic drugs will be altered in the presence of renal or hepatic impairment.

Some analgesic drugs can cause renal or hepatic damage.

Protein binding of drugs may be altered by hepatic reduction in production or uraemic displacement from binding sites.

In renal disease, paracetamol is the simple analgesic of choice.

Morphine can be used with care in mild to moderate renal disease, but fentanyl or oxycodone may be better alternatives.

Non-steroidal anti-inflammatory drugs should be avoided in renal disease.

In hepatic disease with significant impairment, doses of morphine must be reduced and the dosage interval lengthened.

Fentanyl should be avoided in severe hepatic disease.

Chapter.  2936 words. 

Subjects: Critical Care ; Pain Medicine

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