Opioids in renal failure

ANSWER: Selecting opioids suitable for use in renally impaired patients is based on the relative activity of opioid metabolites and their potential for accumulation in renal impairment.1 Fentanyl and alfentanil are opioids which are least likely to cause harm in patients with severe and end-stage renal impairment.1 Although methadone is not renally excreted, it accumulates in tissues with chronic use and so is not recommended.1

The use of dextropropoxyphene and pethidine is not