Use of nonsteroidal anti-inflammatory drugs in the older adult

Abstract

Purpose Annually, approximately 90 million prescriptions are filled for nonsteroidal anti‐inflammatory drugs (NSAIDs) with the number prescribed for older adults approximately three times higher than for younger adults. This article examines the benefits and risk of NSAID use in older adults. Data sources Electronic data collection of research studies, evidence‐based reviews, consensus statements, and guidelines related to the purpose of this article were analyzed if published between 2000 and 2013 in English from Ovid, MEDLINE, and PubMed databases. Conclusions While NSAIDs are commonly used to treat pain and inflammation in older adults, strong consideration must be given to the potential adverse effects. A lack of consistency in the guidelines regarding NSAID use poses further challenges for clinicians in the selection of the best pharmacological approach. When prescribing NSAIDs, adverse events, polypharmacy, comorbidities, and treatment guidelines must be considered. NSAIDs are an appropriate option for pain management in select older adults, often after a trial of acetaminophen and if benefits outweigh risks. Alternative pharmacological and nonpharmacological therapies may be more appropriate in many older adults. Implications for practice The challenge for clinicians prescribing NSAIDs in the treatment of pain in older adults is to utilize safe, individualized, and evidenced‐based pain management regimens.

Chemopreventive Strategies for Inflammation-Related Carcinogenesis: Current Status and Future Direction

“…COX-2 is induced by an inflammatory stimulus (infection, a foreign body, alcohol or tobacco), whereas COX-1 is constitutively expressed in gastrointestinal epithelium, renal tubules and platelets [229,239,262]. The NSAIDs aspirin, diclofenac, ibuprofen, indomethacin, naproxen and piroxicam are nonselective inhibitors of COX isozymes, and therefore, they increase the risk of gastrointestinal events, including bleeding and ulcer [263,264]. Shortly after the first of those reports, selective COX-2 inhibitors (celecoxib, etodolac, meloxicam, rofecoxib) were developed in order to reduce adverse effects [263].…”

Chikungunya Virus Infection: Why Should U.S. Geriatricians Be Aware of It?

“…Of the nonselective NSAIDs, those with the lowest COX‐2 affinity have the least risk of cardiovascular events (e.g., naproxen). Inversely, selective NSAIDs (lower COX‐1 affinity) have the highest cardiovascular risks . Selective and nonselective NSAIDs should be prescribed at the lowest‐possible dose, frequency, and duration.…”

“…Selective and nonselective NSAIDs should be prescribed at the lowest‐possible dose, frequency, and duration. They must be monitored with caution or completely avoided in individuals with moderate to severe renal insufficiency and in those with unexplained anemia, liver insufficiency, and bleeding disorders . Acetaminophen is commonly recommended as first‐line therapy because of its low risk of side effects and drug‐drug and drug‐disease interactions.…”

Practices of healthcare professionals in communicating with nonsteroidal anti-inflammatory drug users in Thailand: a qualitative study

“…Nonsteroidal anti‐inflammatory drugs (NSAIDs) are in widespread use for pain and inflammatory conditions. Many are accessible without a prescription, especially in pharmacy settings, where NSAIDs are frequently purchased . However, there are potentially serious long‐term risks associated with using NSAIDs, in addition to the well‐known side effects, about which those using these medicines should be informed .…”