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Morphine in renal impairment — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentMorphine in renal impairmentGPhC CRA

A palliative care patient with eGFR 18 mL/min/1.73 m² is prescribed regular morphine modified-release for new severe pain. They are opioid-naïve and drowsy after two doses. What is the most appropriate alternative?

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Correct answer: C — Seek urgent specialist or prescriber review because morphine metabolites accumulate

Morphine active metabolites can accumulate in renal impairment, increasing sedation and respiratory depression risk. Specialist palliative care or prescriber review is needed to adjust analgesia and consider alternatives. Adding codeine or promethazine would worsen CNS depression. Crushing modified-release morphine can cause dose dumping.

Reference: BNF; palliative care guidance