Case Report

Oxycodone Accumulation in a Hemodialysis Patient

Authors: Pamela A. Foral, PharmD, BCPS, Joseph R. Ineck, PharmD, Kelly K. Nystrom, PharmD, BCOP

Abstract

Oxycodone and oxycodone-containing analgesics are often used for the relief of pain. In the presence of renal dysfunction, the half-life of oxycodone and metabolites can be prolonged. We describe the case of a 41-year-old chronic hemodialysis patient who received multiple doses of oxycodone/acetaminophen resulting in accumulation of the medication and consequent lethargy, hypotension and respiratory depression. These adverse effects were reversed with multiple bolus doses of naloxone, followed by a continuous infusion administered for 45 hours. Utilizing the Naranjo probability scale, the patient had a “probable” adverse drug reaction to the oxycodone. Oxycodone should be used with caution in patients with chronic renal failure.


Key Points


* Oxycodone-containing analgesics are often used for the relief of pain.


* Oxycodone accumulation in chronic renal failure resulting in lethargy, hypotension, and respiratory depression has not been previously reported.


* Oxycodone should be used with caution in patients with chronic renal failure.

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