Pain is one of the most common and distressing symptoms for people with chronic kidney disease (CKD). Take care when choosing a painkiller (analgesic) as some types should not be taken by people with kidney problems or should only be used with specialist guidance.
When a painkiller is prescribed for you for either acute (short term) or chronic (long term) pain, a stepwise approach is used (this is known as the analgesic ladder). This means that the weakest painkiller is tried first. If you are still in pain, a stronger painkiller will be tried. Your pain and any side effects will be monitored closely.
This page explains the different types of painkillers recommended if you have kidney disease.
What are the different types of painkillers?
The main types of painkiller are:
- Paracetamol
- Nonsteroidal anti-inflammatory drugs (NSAIDs) - for example ibuprofen, naproxen
- Weak opioids - for example codeine, dihydrocodeine, tramadol
- Strong opioids - for example morphine, oxycodone, alfentanil
- Others - for example amitriptyline, gabapentin
The type of painkiller prescribed depends on how severe your pain is and where it is coming from.
Which painkillers are safe to use if I have kidney problems?
Paracetamol in standard doses is safe to take if you have kidney problems. Opioids (also known as opiates) can be used carefully, starting with small doses and increasing the dose slowly if required and only under medical supervision.
Which painkillers should I avoid?
NSAIDs should be avoided if you have chronic kidney disease or have a kidney transplant. This is because they can further reduce your kidney function and cause fluid retention.
They may be safe to take if you are on dialysis and do not produce any urine. However, they can cause bleeding from the stomach and gut and should not be taken for long periods of time or if you have a history of ulcers.
Opioids should be used very carefully, as levels can build up in the body and cause side effects such as drowsiness. They can also cause nausea and constipation, which can be a significant problem if you are on peritoneal dialysis as it can result in the catheter being squashed and therefore unable to drain the fluid correctly.
Always follow your doctor’s or pharmacist’s advice about painkillers and never take more than the recommended dose.
More information about painkillers
Paracetamol
This can be used safely in people whose kidneys are not working well. The standard dose is 500mg-1g every four to six hours, with a maximum of eight tablets in 24 hours. If you weigh less than 50kg or have liver disease you should only take 500mg every 6-8 hours. It is possible to also take a different kind of painkiller if paracetamol is not working for you.
Side effects may include liver damage with prolonged usage.
Paracetamol is often found in cold and cough medicines so be careful not to take two different types of paracetamol at the same time.
NSAIDs (aspirin, ibuprofen, diclofenac, naproxen)
These medications, as tablets, creams or gels, are best avoided if you have kidney disease or a kidney transplant as they can make your kidney function worse. You should therefore only take NSAIDs if they have been approved by your kidney doctor.
NSAIDs are usually taken two or three times a day, depending on the drug and preparation. Some NSAIDs are only available from your GP whereas others (such as ibuprofen) can be bought over the counter. Some cold medicines contain a NSAID so be careful not to take two different NSAIDs at the same time.
Side effects may include indigestion, stomach ulcers, bleeding from the gut, rash, worsening asthma, acute kidney injury, high blood pressure and fluid retention (oedema).
A low dose of aspirin can be taken if prescribed by your doctor, however there is a risk of bleeding even with a small dose.
Opioids
It is possible to become addicted to opioids. For this reason, it is important to only take them under medical supervision.
Weak opioids (codeine)
These medications are usually taken every four to six hours, with a maximum of six doses in 24 hours. People with kidney disease often only need very small and less frequent doses of opioids and often get more side effects, even with a small dose.
Side effects may include constipation, feeling/being sick and drowsiness. Laxatives can help with constipation, but these should only be taken after discussion with your doctor or pharmacist. Try taking the painkillers with food if you feel sick. Avoid driving or operating machinery if you are feeling sleepy.
Strong opioids (morphine, fentanyl, oxycodone)
Morphine and oxycodone are usually taken every four to six hours. They are also available as ‘slow release’ preparations or skin patches which may be taken less frequently, depending on the medicine, but are less suitable for people with kidney disease.
People with kidney disease often only need very small doses of opioids and often get more side effects even with a small dose,
Side effects may include constipation, feeling /being sick and drowsiness. Laxatives can help with constipation, but these should only be taken after discussion with your doctor or pharmacist. Try taking the painkillers with food if you feel sick. Avoid driving or operating machinery if you are feeling sleepy.
Other painkillers (gabapentin, amitriptyline)
These painkillers are often used for neuropathic (nerve) pain. They are usually taken once or twice a day. People with kidney disease often only need very small doses of these medicines and often get more side effects even with a small dose.
Side effects may include drowsiness, anxiety and dizziness.
Important!
You should always store tablets in their original packet, in a cool, dry place and out of the sight and reach of children.
Do not get rid of any expired or unwanted medicines by flushing them down the toilet or throwing them in the bin. Take them to your local pharmacy to dispose of them for you.
Where can I find out more information?
Talk to your GP, kidney doctor or pharmacist if you are in pain. They will be able to discuss which painkillers may be right for you. It is particularly important that you talk to them before changing or starting any medications.
- Kidney Care UK - Medicines for chronic kidney disease (CKD)
- NHS Medicines
- NHS Live Well - Ways to manage chronic medicines
Pain medication for people with chronic kidney disease: download Kidney Care UK's information leaflet
You can download our leaflet on this topic for free.
Publication date: 09/2024
Review date: 09/2027
This resource was produced according to PIF TICK standards. PIF TICK is the UK’s only assessed quality mark for print and online health and care information. Kidney Care UK is PIF TICK accredited.