From the Guidelines
Fentanyl is not removable through dialysis in patients with impaired renal function.
Key Points
- According to the evidence from 1, fentanyl is not removed by dialysis, which is a crucial consideration in patients with renal failure.
- The study 2 recommends careful titration and frequent monitoring of opioids primarily eliminated in urine, such as fentanyl, in patients with renal impairment.
- Another study 3 suggests that fentanyl is one of the safest opioids to use in patients with chronic kidney disease stages 4 or 5.
- Additionally, the study 4 notes that fentanyl is less likely to result in accumulation of active metabolites in renal failure, making it a relatively safe option.
- However, it is essential to use fentanyl cautiously and adjust the dosage according to the patient's renal function, as recommended in 5.
Clinical Implications
- Clinicians should be aware that fentanyl is not removable by dialysis and take this into consideration when managing pain in patients with impaired renal function.
- Fentanyl can be a suitable option for patients with renal impairment, but it requires careful dose adjustment and monitoring to avoid accumulation and toxicity.
- The choice of opioid and dosage should be individualized based on the patient's specific needs and renal function, as emphasized in 2 and 3.
From the FDA Drug Label
Insufficient information exists to make recommendations regarding the use of fentanyl transdermal system in patients with impaired renal or hepatic function. Fentanyl is metabolized primarily via human cytochrome P450 3A4 isoenzyme system and mostly eliminated in urine If the drug is used in these patients, it should be used with caution because of the hepatic metabolism and renal excretion of fentanyl.
The FDA drug label does not provide direct information on whether fentanyl is removable through dialysis in patients with impaired renal function. Key points include:
- Fentanyl is mostly eliminated in urine
- Insufficient information exists to make recommendations for patients with impaired renal function
- Fentanyl should be used with caution in these patients due to renal excretion [6] [7]
From the Research
Fentanyl Removability through Dialysis
- Fentanyl is a synthetic opioid that can be used for pain management in patients with impaired renal function.
- According to a study published in 1997 8, fentanyl clearance is significantly decreased in patients with end-stage renal failure, and this decrease is related to high blood urea nitrogen (BUN) concentrations.
- The study found that the elimination half-life of fentanyl was 382 +/- 205 minutes in patients with end-stage renal failure, and that the volume of distribution and total body clearance were also affected by renal function.
Dialysis and Fentanyl Removal
- A study published in 2004 9 reviewed the literature on the metabolism of opioids in renal failure and dialysis patients, and found that fentanyl is one of the safest opioids to use in patients with end-stage renal disease.
- The study noted that fentanyl is not significantly dialyzable, which means that it is not effectively removed by dialysis.
- Another study published in 2012 10 also recommended fentanyl as a safe opioid for use in patients with end-stage renal disease, due to its pharmacokinetic properties and limited metabolism.
Clinical Implications
- The use of fentanyl in patients with impaired renal function requires careful consideration of the patient's renal function and the potential for decreased clearance and increased risk of toxicity.
- According to a study published in 2016 11, fentanyl intoxication can occur in hemodialysis patients, and can lead to serious side effects such as nonconvulsive status epilepticus.
- A study published in 2007 12 recommended fentanyl as a suitable opioid for use in patients with end-stage renal disease who are not undergoing dialysis, due to its limited metabolism and lack of active metabolites.