BACKGROUND: Tapentadol is generally not recommended in patients with end-stage renal disease on hemodialysis due to concerns about metabolite accumulation and limited safety data. Evidence in this population is scarce, with no major trials to date.

CASE REPORT: A 58-year-old man with end-stage renal disease on hemodialysis developed ischemic monomelic neuropathy after fistula surgery. Previous opioids and tramadol were ineffective; pregabalin, gabapentin, and oxcarbazepine caused intolerable side effects. Due to ongoing citalopram therapy, serotonin-norepinephrine reuptake inhibitor changes were avoided. Tapentadol 75 mg three times daily was started and continued for 20 months, resulting in sustained pain control without observed adverse effects or clinical signs suggestive of drug accumulation; pharmacokinetic drug accumulation could not be assessed because blood and urine drug levels were unavailable.

CONCLUSIONS: This case suggests long-term tapentadol may be a safe and effective pain management option in selected patients with end-stage renal disease on hemodialysis, though further study is needed.

KEYWORDS: Tapentadol, end-stage renal disease, hemodialysis