Renal Failure and the Use of Morphine in Intensive Care

Ball, M.J.; Moore, R Andrew; Fisher, Anthony; McQuay, HJ; Allen, M.C.; Sear, J.W.

doi:10.1097/00132586-198602000-00033

Cited by 3 publications

(2 citation statements)

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“…The majority of clearance is by glucuronidation to the active metabolites, morphine-3-glucuronide (∼ 50%) and morphine-6-glucuronide (5-15%), which are renally excreted; the latter is a more potent analgesic than the parent compound [54], and may accumulate in patients with renal insufficiency [55,56]. The half-life of morphine varies greatly by route of administration, ranging from 1.5-4.5 h for IV, IM, and SQ injection, to 15 h or more for sustainedrelease oral preparations [57,58].…”

Section: Pharmacokinetics and Dynamicsmentioning

confidence: 99%

Critical care sedation for neuroscience patients

Mirski

Hemstreet

2007

Journal of the Neurological Sciences

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Section: Pharmacokinetics and Dynamicsmentioning

confidence: 99%

Critical care sedation for neuroscience patients

Mirski

Hemstreet

2007

Journal of the Neurological Sciences

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“…concentrations, suggested that morphine accumulated in patients with renal failure [30][31][32] and led the authors to postulate that the kidney may play an important role in the metabolism of the drug. However the findings of other workers, [23,25,33] using chromatographic analytical techniques, highlighted the problem of crossreactivity between the parent compound and its metabolites when the RIA technique was used.…”

Section: Effect Of Renal Insufficiencymentioning

confidence: 99%

Pharmacokinetics of Opioids in Renal Dysfunction

Davies

Kingswood

Street

1996

Clinical Pharmacokinetics

159

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Patients with renal insufficiency commonly require the administration of an opioid analgesic to provide adequate pain relief. The handling of morphine, pethidine (meperidine) and dextropropoxyphene in patients with renal insufficiency is complicated by the potential accumulation of metabolites. While morphine itself remains largely unaffected by renal failure, accumulation, as denoted by an increase in both mean peak concentrations and the area under the concentration-time curve, of both the active metabolite (morphine-6-glucuronide) and the principal metabolite (morphine-3-glucuronide, thought to possess opiate antagonist properties) have been reported. The increased elimination half-lives of the toxic metabolites norpethidine and norpropoxyphene in patients with poor renal function administered pethidine and dextropropoxyphene, respectively, makes their routine use ill advised. Case reports of prolonged narcosis associated with the use of both codeine and dihydrocodeine in patients with renal insufficiency call for care to be used when prescribing these agents under such conditions. Although the pharmacokinetics of buprenorphine, alfentanil, sufentanil and remifentanil change little in patients with renal failure, the continuous administration of fentanyl can lead to prolonged sedation.

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