嗎啡類製劑在腎衰竭患者的使用

Using Opioids in Patients with Renal Failure

10.6537/TJHPC.2007.12(2).7

王律凱(Lu-Kai Wang)；蔡佩渝(Pei-Yu Tsai)；蘇育德(Yu-Deh Su)

鴉片類藥物 ； 嗎啡 ； 腎衰竭 ； Opioids ； morphine ； renal failure

安寧療護雜誌

12卷2期（2007 / 05 / 01）

207 - 220

繁體中文

本文探討各種常用嗎啡類製劑和其代謝產物，以及血液透析腎衰竭患者的影響。對於腎衰竭病人不鼓勵使用morphine或codeine, hydromorphone或oxycodone在使用上必須小心且需定期監測其濃度，而methadone和fentanyl/sufentanil則會是相對上較安全的藥物；此外，如腎衰竭患者仍需使用morphine時，則需根據病患的腎絲球廓清率(GFR)來調整其劑量，而對於洗腎患者在血液透析之後也需追加嗎啡劑量。

The clinical utility of most analgesic drugs is altered in the presence of patients with impaired renal function, not simply because of altered clearance of the parent drug, but also through production and accumulation of toxic or therapeutically active metabolites. The author reviews the literature pertaining to the metabolism of several of the commonly used opioids, and the known activity of their metabolites. The effect of renal failure on the pharmacokinetics of these drugs and metabolites is then reviewed. Based on the review, it is recommended that morphine and codeine are avoided in renal failure/dialysis patients; hydromorphone or oxycodone are used with caution and close monitoring; and that methadone and fentanyl/sufentanil appear to be safe to use. Besides, it's also recommended morphine dosage reduction for renal failure patients, and based on patient's GFR (glomerular filtration rate) to modify the morphine dosage. Extra dosing of morphine is also needed during or after dialysis to achieve ideal pain control. The least dialyzable opioids seems to be comparative safe drug for renal failure or dialysis patients.