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01-10-2010 | Review Article

Should Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) be Prescribed to the Older Adult?

Authors: Robert L. Barkin, Mihail Beckerman, Steven L. Blum, Frank M. Clark, Eun-Kyu Koh, Dickson S. Wu

Published in: Drugs & Aging | Issue 10/2010

Abstract

The prevalence of chronic pain increases with age, exceeding 50% in individuals aged ≥65 years. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a mainstay of chronic pain management but carry significant dose-related risks of cardiovascular, renal, haematological and other systemic adverse events (AEs). Older patients have an increased risk of these AEs and are more likely to take multiple medications that can potentially interact with NSAIDs. In particular, older patients are more likely to have cardiovascular disease and a natural age-related decline in renal function, increasing the risks of cardiovascular, haematological and renal AEs. Given these risks, recent guidelines for the management of chronic pain in the elderly recommend using NSAIDs rarely and only in carefully selected patients. NSAIDs currently available in the US fall into three categories: nonselective NSAIDs that act via inhibition of cyclo-oxygenase (COX)-1 and COX-2; celecoxib, a selective inhibitor of COX-2; and topical NSAIDs that inhibit both COX-1 and COX-2 but result in much less systemic NSAID exposure than oral formulations. Topical NSAIDs have demonstrated efficacy similar to oral NSAIDs, with an incidence of AEs similar to placebo; however, these agents are an option only in patients with localized pain in superficial joints. Safe pain management in older patients therefore requires cautious choice of selective and nonselective oral NSAIDs, topical NSAIDs or non-NSAID analgesics. This article discusses the risks and benefits of NSAID therapy, reviews its mechanism of action as the source of adverse effects and provides recommendations for maximizing NSAID safety, particularly in older patients. Articles cited in this review were identified via a search of PubMed (January 2005 to November 2009) and a manual search of reference lists from the articles identified in that search. Priority was given to articles discussing NSAID use in older populations, clinical trials of high quality, reports on NSAID safety and AEs, and treatment guidelines.

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Title: Should Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) be Prescribed to the Older Adult?
Authors: Robert L. Barkin
Mihail Beckerman
Steven L. Blum
Frank M. Clark
Eun-Kyu Koh
Dickson S. Wu
Publication date: 01-10-2010
Publisher: Springer International Publishing
Published in: Drugs & Aging / Issue 10/2010
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI: https://doi.org/10.2165/11539430-000000000-00000

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Should Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) be Prescribed to the Older Adult?

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

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Other articles of this Issue 10/2010

Could Geriatric Characteristics Explain the Under-Prescription of Anticoagulation Therapy for Older Patients Admitted with Atrial Fibrillation?

Oral Colchicine (Colcrys®) in the Treatment and Prophylaxis of Gout

Effectiveness of Guideline-Recommended Cardiac Drugs for Reducing Mortality in the Elderly Medicare Heart Failure Population

Risk of Falls and Fractures in Older Adults Using Antipsychotic Agents

Quality-of-Life Considerations in the Treatment of Early-Stage Breast Cancer in the Elderly

Changes in Under-Treatment after Comprehensive Geriatric Assessment

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page