Methadone use in patients with chronic renal disease.
ABSTRACT Methadone disposition was studied in three patients receiving chronic methadone treatment and having chronic renal disease: one oliguric patient during peritoneal dialysis, one anuric patient on hemodialysis, and one patient following renal transplantation. In all three patients plasma levels of methadone remained within the desired therapeutic range (0.09--0.68 microgram/ml) for the doses received (40-50 mg/day). Elimination of methadone and its metabolites was almost exclusively by the fecal route in the anuric patient. Less than 1% of the daily dose was removed by peritoneal dialysis or hemodialysis. There was no laboratory or clinical evidence for accumulation of either methadone or its metabolites, suggesting that methadone is an appropriate narcotic to use in patients with renal disease.
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ABSTRACT: There is increasing international attention in efforts to integrate palliative care principles, including pain and symptom management, into the care of patients with advanced chronic kidney disease (CKD). The purpose of this scoping review was to determine the extent, range, and nature of research activity around pain in CKD with the goal of (i) identifying gaps in current research knowledge; (ii) guiding future research; and (iii) creating a rich database of literature to serve as a foundation of more detailed reviews in areas where the data are sufficient. This review will specifically address the epidemiology of pain in CKD, analgesic use, pharmacokinetic data of analgesics, and the management of pain in CKD. It will also capture the aspects that pertain to specific pain syndromes in CKD such as peripheral neuropathy, carpal tunnel syndrome, joint pain, and autosomal dominant polycystic kidney disease.Seminars in Dialysis 02/2014; · 2.25 Impact Factor
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ABSTRACT: Chronic kidney disease is common and patients with many co-morbid conditions frequently have to undergo surgical procedures and, therefore, require effective pain management. The pharmacokinetics of various analgesic agents are not well studied in patients with chronic kidney disease and the risk of accumulation of the main drug or their metabolites, resulting in serious adverse events, is a common scenario on medical and surgical wards. It is common for these patients to be cared for by 'non-nephrologists' who often prescribe the standard dose of the commonly used analgesics, without taking into consideration the patient's kidney function. It is important to recognize the problems and complications associated with the use of standard doses of analgesics, and highlight the importance of adjusting analgesic dosage based on kidney function to avoid complications while still providing adequate pain relief.F1000Research. 01/2013; 2.
Article: Treatment of cancer pain[Show abstract] [Hide abstract]
ABSTRACT: Pain is a common symptom in patients with cancer, and requires careful assessment and appropriate therapy in order to improve quality of life. Treatment for pain requires modification in the presence of renal disease. NSAIDs should be avoided whenever possible, as they all (including the cyclo-oxygenase-2-specific inhibitors) have detrimental effects on kidney function. Morphine is not the preferred opioid in renal insufficiency and renal failure as it causes retention of active metabolites with subsequent adverse effects. Oxycodone and tramadol cause fewer adverse effects, and fentanyl may be the first choice in this setting as its pharmacokinetics are unaffected by renal function. Of the commonly used co-analgesics, ketamine is not affected by renal disease, while tricyclic antidepressants and gabapentin show increased rates of adverse effects. Co-analgesics commonly used to treat bone pain such as calcitonin and bisphosphonates need to be used with caution in renal disease. Psychological interventions might be particularly useful in patients with renal disease as they effectively address issues of chronic disease management, and have no adverse effects in these patients. The use of interventional techniques requires careful planning in patients with renal disease as co-morbidities may affect outcome and cause adverse effects.American Journal of Cancer 3(4).