From the Guidelines
Oxycodone should be used with caution in patients with renal insufficiency, as it may accumulate in the body due to decreased clearance, potentially leading to toxicity, and dosage adjustments are often necessary for patients with moderate to severe kidney impairment. When taken as prescribed in appropriate doses, oxycodone itself doesn't typically cause significant kidney damage in people with normal kidney function 1. However, several factors related to oxycodone use warrant caution. Oxycodone can cause urinary retention in some patients, which may indirectly stress the kidneys. In cases of overdose or when combined with other substances, oxycodone can lead to respiratory depression and decreased blood pressure, potentially reducing blood flow to the kidneys and causing acute kidney injury.
Key Considerations
- For patients with pre-existing kidney disease, oxycodone should be used cautiously as the medication may accumulate in the body due to decreased clearance, potentially leading to toxicity 1.
- Dosage adjustments are often necessary for patients with moderate to severe kidney impairment, and opioids primarily eliminated in urine, such as fentanyl, oxycodone, and hydromorphone, should be carefully titrated and frequently monitored for risk or accumulation of the parent drug or active metabolites 1.
- Dehydration while taking oxycodone can further stress kidney function, so maintaining adequate fluid intake is important.
- If you're taking oxycodone and have kidney concerns, discuss this with your healthcare provider who can monitor your kidney function and adjust treatment accordingly.
Recommendations for Use
- Clinicians should perform more frequent clinical observation and opioid dose adjustment for patients with renal or hepatic impairment who receive opioids 1.
- For patients with renal impairment currently treated with an opioid, clinicians may rotate to methadone, if not contraindicated, as this agent is excreted fecally 1.
From the FDA Drug Label
Oxycodone is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Because oxycodone is known to be substantially excreted by the kidney, its clearance may decrease in patients with renal impairment. Initiate therapy with a lower than usual dosage of oxycodone hydrochloride tablets and titrate carefully.
Oxycodone may affect kidney function. The drug label indicates that oxycodone is substantially excreted by the kidney, and patients with impaired renal function may be at a greater risk of adverse reactions.
- Key points:
- Oxycodone clearance may decrease in patients with renal impairment.
- Initiate therapy with a lower than usual dosage and titrate carefully in patients with renal impairment.
- Monitor renal function, especially in elderly patients who are more likely to have decreased renal function 2.
From the Research
Opioid Use and Kidney Function
- Opioids can affect kidney function, particularly in patients with pre-existing kidney disease 3, 4, 5, 6.
- The use of opioids in patients with chronic kidney disease (CKD) requires careful consideration and monitoring due to the risk of adverse events and altered pharmacokinetics 3, 4, 6.
Safe Use of Opioids in CKD Patients
- Oxycodone and hydromorphone can be safely used in CKD patients, but require adequate dosage adjustments 3, 6.
- Buprenorphine and fentanyl may be considered first-line opioids in the management of pain in CKD patients, but fentanyl is not suitable for patients undergoing hemodialysis 3, 4.
- Tapentadol does not require dosage adjustment in mild-to-moderate renal impairment, but its use in end-stage renal disease (ESRD) is not well-studied 3.
Risks and Considerations
- The accumulation of morphine and codeine metabolites can cause neurotoxic symptoms, making them less suitable for CKD patients 3, 6.
- Common comorbidities in CKD patients can exacerbate opioid-related side effects, and careful monitoring is necessary to minimize risks 3, 4, 6.
- Opioid-induced constipation can be managed with peripherally-acting μ-opioid receptor antagonists (PAMORAs), such as naldemedine, which does not require dose adjustment in CKD and HD patients 3.
Acute Kidney Injury and Opioid Use
- Opioid use has been associated with an increased risk of acute kidney injury, particularly in certain populations 7.
- Further research is needed to fully understand the relationship between opioid use and kidney function, as well as to identify at-risk populations and develop preventive measures and novel therapeutic options 7.