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Pain management can be challenging in patients with acute or chronic renal failure. Opioid medications should always be used with caution, but some are safer than others. Morphine and codeine specifically should be avoided in these patients due to accumulation of active metabolites that can prolong the duration of effect and adverse events.
| Opioid | Renal Failure Impacts | Renal Failure Recommendation | Dialysis Recommendation |
| Morphine | Active metabolites accumulate | | |
| Codeine | Active metabolites accumulate | | |
| Hydromorphone | Minimal active metabolites | | |
| Oxycodone | Minimal active metabolites | | |
| Fentanyl | No active metabolites | | |
| Methadone | Active metabolites are inactive | | |
References
Dean M. Opioids in renal failure and dialysis patients. J Pain Symptom Mange 2004;28:497-504.