Peripherally restricted kappa-opioid agonist
Difelikefalin
Brand names: Kapruvia
Adult dose
Dose: 0.5 micrograms/kg IV at end of haemodialysis 3× weekly
Route: IV (post-dialysis)
Frequency: 3× weekly
Clinical pearls
- NICE TA890: moderate-to-severe pruritus in adults on haemodialysis
- Specialist renal centre prescribing
- KDIGO CKD-MBD / pruritus guidance — limited prior options (gabapentin off-label)
Contraindications
- Hypersensitivity
Side effects
- Dizziness
- Somnolence
- Mental status changes
- Diarrhoea
- Hyperkalaemia
- Falls (elderly)
Interactions
- CNS depressants (additive sedation, despite peripheral restriction)
- Other opioids
Monitoring
- Pruritus severity (WI-NRS)
- Mental status
- Falls
- Potassium
Reference: BNF; NICE TA890; KDIGO; SmPC; https://bnf.nice.org.uk/drugs/difelikefalin/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Morphine Milligram Equivalents (MME) Calculator · Pain / Opioids
- Opioid Conversion / Equianalgesic Guide · Pain Management
- Numeric Rating Scale (NRS) Pain Assessment and Management · Pain Management
- Finnegan Neonatal Abstinence Scoring Tool (FNAST) · Neonatal Abstinence Syndrome
- Modified Finnegan Neonatal Abstinence Score (NAS) · Neonatal
- Withdrawal Assessment Tool (WAT-1) for Paediatric Iatrogenic Withdrawal · Critical Care
Pathways
- Hyperkalaemia Management · UK Kidney Association Guidelines 2020; NICE CKD Guidelines
- Rhabdomyolysis · Renal Association 2018; UpToDate 2024
- Hypocalcaemia (Adult) · Society for Endocrinology
- SIADH (Endocrine Perspective) · European Hyponatraemia Guidelines 2014
- Hepatorenal Syndrome · EASL 2018; ICA 2015
- Acute Kidney Injury (AKI) · KDIGO 2012 / NICE AKI 2019