Introduction
Kidney diseases are accompanied by specific symptoms of reduced kidney function and other problems. A major problem with kidney diseases is the correct selection of important drugs. Nearly all drugs are metabolized in the human body and must be excreted afterwards.
The excretion of the substances can take place via two main systems: Particularly water-soluble substances can be transported in the urine and thus excreted via the kidneys. Substances that are more likely to be fat-soluble are metabolized in the liver and excreted in the bowel movement. The different ways of excretion also play an important role when taking painkillers, because in the case of kidney diseases, as few painkillers as possible should be used that are excreted via the kidneys.
These painkillers are beneficial in kidney disease
Non-opioid analgesics (analgesics) Paracetamol Metamizol (Novalgin®, novamine sulfone) Flupirtine (no longer approved in Germany since 2018) Opioids Tramadol Tilidine Hydromorphone Piritramide
- Non-opioid analgesics (painkillers) Paracetamol Metamizol (Novalgin®, novamine sulfone) Flupirtine (no longer approved in Germany since 2018)
- Paracetamol
- Metamizole (Novalgin®, Novamine sulfone)
- Flupirtin (no longer approved in Germany since 2018)
- Opioids Tramadol Tilidine Hydromorphone Piritramide
- Tramadol
- Tilidin
- Hydromorphone
- Piritramid
- Paracetamol
- Metamizole (Novalgin®, Novamine sulfone)
- Flupirtin (no longer approved in Germany since 2018)
- Tramadol
- Tilidin
- Hydromorphone
- Piritramid
These painkillers are unfavorable in case of kidney disease
NSAID Diclofenac Ibuprofen Indometacin ASS (acetylsalicylic acid) Naproxen Celecoxib, Etoricoxib, Parecoxib Opioids Oxycodone
- NSAID Diclofenac Ibuprofen Indometacin ASS (acetylsalicylic acid) Naproxen Celecoxib, Etoricoxib, Parecoxib
- Diclofenac
- Ibuprofen
- Indomethacin
- ASS (acetylsalicylic acid)
- Naproxen
- Celecoxib, Etoricoxib, Parecoxib
- Opioids Oxycodone
- Oxycodone
- Diclofenac
- Ibuprofen
- Indomethacin
- ASS (acetylsalicylic acid)
- Naproxen
- Celecoxib, Etoricoxib, Parecoxib
- Oxycodone
The NSAIDs (non-steroidal anti-inflammatory drugs) are a group of drugs that have anti-inflammatory, analgesic and antipyretic effects. Classical active ingredients of this group are diclofenac, ibuprofen, indometacin, ASS (acetylsalicylic acid = aspirin) and naproxen. In addition, there are some active ingredients that have a more specific effect, including celecoxib, etoricoxib and parecoxib.
All non-steroidal anti-inflammatory drugs are mainly excreted via the kidneys. Therefore, in the case of renal insufficiency (kidney weakness), the substances can accumulate in the body because the active ingredients cannot be excreted as quickly. For this reason, a dose adjustment with a reduced dosage of the painkiller is necessary in case of poor kidney function.
It would be even better to do without NSAIDs completely and instead resort to other painkillers. Because non-steroidal anti-inflammatory drugs are excreted via the kidney, they can also damage the kidney if taken over a longer period of time and thus cause temporary or chronic kidney damage. Those who already have borderline kidney function before taking painkillers are therefore also better advised to take painkillers other than NSAIDs.
Non-steroidal antirheumatic drugs can also cause problems in the digestive tract. They are particularly common in causing mucous membrane ulcers in the stomach or duodenum. NSAIDs should therefore be given in combination with proton pump inhibitors (stomach protection).
Metamizole (also known as novamine sulfone or commercially available as Novalgin®) is an analgesic and antipyretic substance. The exact mode of action of Novalgin® is not yet fully understood, but a mechanism of action by inhibition of prostaglandins (a substance that accelerates inflammatory reactions) as well as an effect on pain processing in the brain is suspected. With regard to kidney diseases Novalgin® is in most cases preferable to non-steroidal anti-inflammatory drugs.
For example, if renal function is only slightly impaired, the dose does not need to be adjusted as no danger to the damaged kidney is to be expected.Most painkillers, which do not have a bad effect on the kidney, damage the liver with prolonged use. But in the case of Novalgin®, even in case of mild to moderate liver damage, no special precautions and lower doses need to be taken. In general Novalgin® is considered to be a pain reliever with few side effects.
However, a rare but serious side effect can be a disturbance of blood formation, which leads to a so-called agranulocytosis (significant reduction of the number of granulocytes, a subgroup of white blood cells needed for the immune defense). Here we go: Side effects of Nolvagin®Morphine belongs to the group of so-called opioids. These are powerful painkillers that are available in a wide range of strengths and active ingredients.
Morphines can be taken in principle for kidney diseases. However, in the case of a pronounced disturbance of the kidney function, higher concentrations of the active substance may be present in the body over a longer period of time. This is probably due to the fact that the excretion products of morphines cannot be excreted as quickly as in a healthy kidney when kidney function is poor.
Morphines and the metabolically converted products of morphine can be detected mainly in the liver, kidney and gastrointestinal tract. Although higher concentrations of morphine and its metabolites may occur in the kidney, it is not known that morphines damage the kidney in normal doses. Therefore, there is no need to fear that kidney function could be impaired by the normal administration of morphine preparations even in the case of kidney diseases.
However, due to the reduced excretion when kidney function is particularly low, dose adjustments may be necessary, as otherwise the active substance may accumulate in the body to a high degree. This has similar effects to an overdose. This results in reduced respiratory drive, dizziness, disturbances of consciousness, an increase in heart rate and a drop in blood pressure.
Aspirin® contains the active ingredient acetylsalicylic acid (ASA for short) and is a pain medication that also prevents the cross-linking of blood platelets and can therefore also be used to thin the blood. As a result, there has now been a shift away from using Aspirin® increasingly as an analgesic. Instead, it plays an important role in the treatment of cardiovascular diseases, such as coronary artery disease, and in the prevention of strokes, acute arterial occlusion and heart attacks.
In contrast to non-steroidal anti-inflammatory drugs, aspirin can also be used as a painkiller for kidney disease. Only from a moderate kidney weakness (renal insufficiency) the substance may no longer be used. The guideline value above which there is a contraindication to taking Aspirin® in cases of renal insufficiency is a GFR (glomerular filtration rate = value for the excretory function of the kidney) of less than 30 ml/min.
Paracetamol is an analgesic that also has a fever-reducing and pain-relieving effect. It can be used as an analgesic for both adults and children (in a dosage adapted to age and weight). The exact mechanism of action of paracetamol has not been clarified, but it is assumed that the effect is mainly felt in the spinal cord and in the brain itself.
Since paracetamol is largely metabolized and excreted via the liver, there is usually no reason to fear kidney disease. Thus, people with kidney disease can usually take the same dose of paracetamol at the same intervals (ideally at least 6 hours) as “healthy” people with kidney disease. Only in cases of severe kidney insufficiency (kidney weakness) with a glomerular filtration rate (GFR = value for kidney function) of less than 10 ml/min should a lower dose of paracetamol be taken, as otherwise the substance may accumulate in the body and cause symptoms of poisoning. In this case, the interval between two times of taking paracetamol should be at least 8 hours. While healthy adults can take up to 4g of paracetamol per day, a maximum of 2g of paracetamol per day should be taken for kidney diseases.
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