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Preferred analgesic medications for chronic pain management in CKD stages 4 and 5

Preferred analgesic medications for chronic pain management in CKD stages 4 and 5
WHO step Recommended Use with caution Do not use
1 Acetaminophen   NSAIDs
2    

Codeine

Tramadol
3

Hydromorphone

Fentanyl, Alfentanil

Methadone

Buprenorphine		 Oxycodone

Morphine

Meperidine

Propoxyphene
Adjuvant

Gabapentin

Pregabalin

Carbamazepine

TCAs		  
CKD: chronic kidney disease; WHO: World Health Organization; NSAID: nonsteroidal antiinflammatory drug; TCA: tricyclic antidepressant.
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