Morphine renal disease

Hydromorphone is easily available and titrateable, inexpensive (except extended release), and well tolerated. It causes less pruritus than morphine. It is equivocal whether it causes less nausea in cases where substantial doses are administered. Hydromorphone can be used in a multimodal approach to treat both acute and chronic pain. It carries less risk of toxic metabolites when compared to morphine and meperidine in patients with renal disease. Overdoses are readily treated with the antagonist naloxone. 

Use in hepatic or renal disease the elimination half-life of morphine may be prolonged in patients with reduced metabolic rates and with hepatic and/or renal dysfunction. Hence, care shoidd be exercised in administering preservative-free morphine epiduraUy to patients with these conditions, since high blood morphine levels, due to reduced clearance, may take several days to develop. 

Amantadine may exacerbate central nervous system effects in disorders. Dosages must be adjusted for patients with renal disease or congestive heart failure. Since amantadine interacts with morphine caution is required when these two drugs are administered together. 

The biggest drawback of M6G is its tendency to accumulate in patients with renal dysfunction. Plasma elimination half-time in non-dialyzed patients with end-stage renal disease can approach 30 hours. Another disadvantage is its slow passage across the blood-brain barrier, prolonging its onset of action relative to morphine. 

Codeine, also known as methylmorpliine, C H2 NOt H20, is a colorless white crystalline substance, mp 154.9 C, slightly soluble in water, soluble in alcohol and chloroform, effloresces slowly in dry air. Codeine is derived from opium by extraction or by the methylation of morphine. For medical use, codeine is usually offered as the dichlotide, phosphate, or sulfate. Codeine is habit forming. Codeine is known to exacerbate urticaria (familiarly known as hives). Since codeine is incorporated in numerous prescription medicines for headache, heartburn, fatigue, coughing, and relief of aches and pains, persons with a history of urticaria should make this fact known to their physician. Codeine is sometimes used ill cases of acute pericarditis to relieve severe chest pains in early phases of disease. Codeine is sometimes used in drug therapy of renal (kidney) diseases. 

Codeine and morphine should be used with caution in hypotension, hypothyroidism, asthma (avoid during an attack) and decreased respiratory reserve, shock, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, pregnancy and breastfeeding. They may precipitate coma in patients with hepatic impairment and as such, they should be avoided or a reduced dose used. In patients with renal impairment, the dose should be reduced or they should be avoided. If used in the elderly and debilitated, the dose should be reduced. 

Experience with methadone in cancer pain is limited. Its long half-life tends to produce delayed toxicity, especially in older patients, but in chronic renal insufficiency and stable liver disease methadone is safe, unlike morphine. 

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