- This guideline applies to haemodialysis (HD), peritoneal dialysis (PD) and patients with creatinine clearance (CrCl) <30ml/min. These patients are at greater risk of toxicity from analgesia due to potential accumulation and an increased sensitivity to side effects.
- The doses quoted are suggested starting doses; these can be gradually increased, as necessary, according to response. Review analgesia regularly, at least once a day. Increases to dose or frequency will require consideration of degree of pain relief versus tolerability of side effects and will be patient specific.
- Avoid modified release (MR) preparations, in renal impairment due to risk of toxicity (drug half-life will be extended and will result in accumulation)
- To calculate estimated creatinine clearance in patients with renal impairment (NB do not use for HD or PD patients) NHS Highland Renal MDT recommends the use of MDCalc (insert link). Refer to TAM-prescribing medicines in renal impairment for further guidance or contact pharmacy.
If calculating manually the equation is: CrCl (ml/min) = (140 – age) x body weight (kg) x 1.23 for men or 1.04 for women. Creatinine (micromol/l)
This equation is less accurate at extremes of weight. In obese patients use ideal body weight (IBW)/adjusted body weight as per MD Calc. If underweight use actual body weight. Seek advice from pharmacy for patients with amputations.
Ideal body weight
Males = 50kg + 0·9kg for every cm above 150cm
Females= 45·5kg + 0·9kg for every cm above 150cm