Pain management can be incredibly difficult in the elderly due to the high risk of potential side effects. NSAIDs are some of the most commonly used medications for pain. Here’s 5 reasons why NSAIDs in the elderly may not be such a good idea.
1. NSAIDs can cause GI bleeding without any additional help. When working with the elderly we often run into the complication of polypharmacy. Many elderly patients are on anticoagulant and antiplatelet medications which can significantly increase the risk of a GI Bleed.
2. When you’ve seen numerous hospitalizations due to NSAIDs, I can’t help but wonder why these medications are over the counter? Concern #2 is that many patients equate over the counter = safe. Poorly monitored use of NSAIDs can lead to bad outcomes and poor monitoring is more likely if patients are self treating without speaking to a pharmacist or other qualified healthcare professional.
3. NSAIDs can exacerbate kidney disease which is common problem in the elderly. Many elderly patients are already necessarily on drugs for CHF/hypertension like diuretics and ACE Inhibitors worsening the risk for acute renal failure. If you are a student reading this, remember the afferent/efferent rant that I suspect one of your professors taught you. Clinically, it matters.
4. With the use of NSAIDs, there is a US boxed warning. NSAIDs are associated with an increase in the risk of cardiovascular thrombotic events (like MI and stroke).
5. I mentioned the risk of acute kidney injury above due to concomitant use with ACE/diuretics etc. Another disease state that can be significantly exacerbated by NSAIDs is CHF. NSAIDs can contribute to fluid retention leading to increasing symptoms of CHF.
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Eric Christianson, PharmD, BCPS, CGP
Great !
So would you recommend avoiding NSAIDs in the elderly altogether?
There are certain circumstances where it might be necessary to use them, but in general, they are not going to be the first analgesic that I’m going to look at using in an elderly patient if I can help it.
So then what is?
And if you say APAP, then what’s second line to that for general or osteoarthritis related pain?
There are definitely risks to other medications (like opioids) as well and there is no silver bullet to treat pain. It is really important to make sure we try/consider non-drug interventions as well! If localized, can consider topical products as well!
An additional concern should be raised, in my opinion, regarding NSAIDs use from people on cardioprotective low-dose daily aspirin. There is evidence to suggest that ibuprofen and possibly other NSAIDs as well may hinder aspirin’s cardioprotective effect by displacing it from the acetylation site of platelet COX. Careful consideration of benefits and risks as well as proper dosage timing should take place in these situations.
Source: http://www.medscape.com/viewarticle/829422
Thanks for sharing!