Dihydrocodeine in renal failure: further evidence for an important role of the kidney in the handling of opioid drugs.

Abstract

Mean (SD) sublingual temperatures (°C) before, immediately after, and one hour after exercise in 10 healthy men given placebo or naloxonefive minutes before exercise The pharmacokinetics of a single oral dose of dihydrocodeine were studied in nine patients with chronic renal failure treated by haemodialysis and nine subjects with normal renal function. In the patients the mean peak plasma dihydrocodeine concentration occurred later and the area under the curve was greater than in the normal subjects. Furthermore, the drug was still detectable after 24 hours in all the patients but only three of the normal subjects. These data, together with those obtained from previously published clinical case reports, contradict the traditional view that the body's ability to cope with opioid drugs is not altered in renal failure.

Treatment of pain in patients with renal insufficiency: The World Health Organization three-step ladder adapted

“…It has been shown that the area under the concentration-time curve of dihydrocodeine in hemodialyzed patients receiving usual dosage of the drug was as much as 70% higher than in control subjects. 8 This was confirmed in patients with chronic renal failure taking dihydrocodeine before and after successful renal transplantation, reflecting the influence of the kidney in the excretion of the drug. 9 There are several reports of inadvertent relative overdosage in the presence of renal failure, 6 but still no recommendations are available.…”

A Transit Compartment Model Unmasks OxyContin's Reflective Pharmacokinetics From Urine Measurements in Humans

“…Opioids undergo both glomerular filtration and tubular secretion. 25 In the unlikely event of any renal tubular reabsorption of oxycodone and its metabolites into the blood, our results would represent underestimates.…”

Pharmacokinetics of Tilidine in Terminal Renal Failure

“…Plasma concentration-time profiles of tilidine, nortilidine, and bisnortilidine in patients with end-stage renal failure measured in the dialysis-free interval (mean ± SD, n = 9). deine, 14 methadone, 15 dextropropoxyphene, 16,17 and fentanyl. 18 In conclusion, the pharmacokinetics of the active metabolite nortilidine formed after administration of tilidine is only slightly affected in functionally anephric patients.…”