What opioid should be adjusted for patients with renal impairment?

The selection of morphine as the opioid that requires adjustment for patients with renal impairment is justified because morphine and its metabolites are primarily excreted by the kidneys. In individuals with renal dysfunction, the accumulation of these metabolites can lead to increased risk of side effects, including sedation and respiratory depression.

Patients with compromised renal function may experience a prolonged half-life of morphine due to decreased clearance, which could result in higher plasma concentrations and potentially dangerous adverse effects. Therefore, dosage adjustments or cautious monitoring are essential when administering morphine to patients with renal impairment.

Other opioids listed, while they may also require some consideration in renal impairment, do not have the same level of accumulation risk as morphine. Adjustments for those drugs might not be as critical, making morphine the primary concern in this context.