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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