Dihydrocodeine--a reversible cause of renal failure?

Two patients who developed severe narcosis and acute renal failure following therapeutic doses of dihydrocodeine are reported. The administration of naloxone produced an increase in respiratory minute volume and an improved level of consciousness. In addition, there was evidence of reversal of their renal failure with an increased urine output and creatinine clearance during the period of naloxone administration. Although the antidiuretic effect of opioids is well documented, opioids have not previously been incriminated in the aetiology of renal failure. The possible mechanism for this is discussed and the risks associated with the administration of dihydrocodeine to patients with renal failure or the elderly are emphasized.