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Opioid choice in CKD — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentOpioid choice in CKDGPhC CRA

A 74-year-old woman with CKD stage 4 is prescribed morphine sulfate oral solution 10 mg every 4 hours for severe back pain. Her eGFR is 22 mL/min/1.73 m2 and she is opioid-naive. What is the most appropriate action?

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Correct answer: D — Query morphine choice and dose because accumulation may cause toxicity

Morphine and active metabolites can accumulate in significant renal impairment, increasing risk of sedation and respiratory depression. An opioid-naive older patient with eGFR 22 mL/min/1.73 m2 needs prescriber review for safer choice and dosing. Adding NSAIDs or codeine would create further safety problems.

Reference: BNF; NICE CKS