American Board of Family Medicine (ABFM) Practice Exam

Which pain medication is safe to use in patients with renal failure?

1. Fentanyl

2. Methadone

3. Ibuprofen

4. Acetaminophen

The correct answer is: Fentanyl

Fentanyl is a synthetic opioid that is primarily metabolized by the liver, and it has minimal renal excretion. This characteristic makes it a safer option for patients with renal failure compared to other pain medications. In individuals with compromised kidney function, many traditional medications can accumulate and potentially lead to toxicity or adverse effects due to reduced clearance. While methadone, ibuprofen, and acetaminophen have their uses, they pose varying risks in patients with renal impairment. Methadone, although also predominately hepatic, can still be problematic due to its long half-life and potential for accumulation. Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can worsen renal function and increase the risk of acute kidney injury. Acetaminophen, while generally safer in moderate doses, can still be risky in cases of severe liver dysfunction, which may also affect its metabolism and clearance. Given these factors, fentanyl stands out as a suitable pain management option for patients suffering from renal failure, allowing for effective pain control with a lower risk of adverse renal-related effects.