Limited Dialysis Clearance for Oxycodone, Noroxycodone

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Significant mean reduction in oxycodone, noroxycodone arterial concentrations.
Significant mean reduction in oxycodone, noroxycodone arterial concentrations.

(HealthDay News) -- For patients with chronic pain with end-stage renal disease, oxycodone and noroxycodone have limited dialyzability, according to a study published online in Pain Practice.

Boaz Gedaliahu Samolsky Dekel, MD, PhD, from the University of Bologna in Italy, and colleagues examined the effect of standard hemodialysis (HD) and online hemodiafiltration (HDF) methods on the plasma concentration of oxycodone and its metabolites in 20 chronic pain patients with end-stage renal disease. Patients were stably treated with oral controlled-release oxycodone. Plasma concentrations of the studied compounds were assessed at different time points during dialysis.

The researchers observed an overall reduction trend over time in the mean plasma concentrations of oxycodone and noroxycodone in the sample, but the reduction was less enhanced for noroxycodone. A significant mean reduction was seen in oxycodone and noroxycodone arterial concentrations, which was greater with HDF (54 and 27 percent, respectively) than with HD (22 and 17 percent, respectively). A more stable and linear clearance prediction was seen with HDF (approximately 85 mL/min); for HD, clearance of oxycodone decreased and noroxycodone clearance increased with increasing arterial concentration.

"This evidence will contribute toward considerations as to the safety of the use of oxycodone in dialysis patients in the future," the authors write.

One author disclosed financial ties to Mundipharma Pharmaceuticals.


1. Samolsky Dekel BG, Donati G, Vasarri A, et al. Dialyzability of Oxycodone and Its Metabolites in Chronic Noncancer Pain Patients with End-Stage Renal Disease. Pain Practice. doi: 10.1111/papr.12483.

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