Opioids renal disease

Figure 7.6 Structure of remifentanil and its major metabolite formed by ester hydrolysis. contrast, alfentanil has an intermediate hepatic extraction (0.3-0.5) and alfentanil clearance will be sensitive to changes in both liver blood flow and reduced enzyme capacity in patients with liver disease. Although the kidneys play a minor role in the elimination of most opioids, renal disease can influence their pharmacokinetic profile, secondary to alterations in plasma proteins and intra- and extravascular volumes. Neither the pharmacokinetics nor the pharmacodynamics of remifentanil is significantly altered in patients with liver or renal disease.

There are numerous relative contraindications to combination opioids and NSAIDs. They include but are not limited to a past medical history of GI bleeding, history of chronic renal disease, a history of abuse of drugs or other substances, a history of seiziu es related to head trauma, brain tumor, or increased intracranial pressure, or documented urinary retention with use of narcotics. 

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