Peripherally restricted kappa-opioid agonist

Difelikefalin

Brand names: Kapruvia

Difelikefalin is an agent used to treat moderate to severe pruritus associated with chronic kidney disease in adults on haemodialysis.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It is a peripherally restricted, selective kappa opioid receptor agonist that reduces itch through actions on peripheral sensory neurones and immune cells, with limited central penetration.

Prescribing in practice

Dizziness, somnolence and altered mental status can occur, with an additive risk when combined with sedating or centrally acting agents.
It is administered intravenously into the dialysis circuit at the end of haemodialysis sessions.
Caution is advised in patients receiving other CNS depressants because of additive sedation.

Monitoring

Monitor itch severity and response, and watch for dizziness, drowsiness or mental status changes.

Counselling the patient

This medicine is given through your dialysis line at the end of your session.
Tell the team if you feel unusually drowsy or dizzy.
It is intended to relieve itching and may take some time to show full benefit.

Evidence & guidelines

Difelikefalin is licensed for chronic kidney disease-associated pruritus in haemodialysis patients on the basis of randomised controlled trial data.

Reference: NICE TA890; KDIGO; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways