Toxicity Profiles of Commonly Used Anti-Inflammatory Drugs in Geriatrics (original) (raw)
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Toxicity of Nonsteroidal Anti-Inflammatory Drugs in the Elderly: Is Advanced Age a Risk Factor?
The American Journal of Medicine, 1997
We reviewed the pharmacokinetic, physiologic and epidemiologic data concerning nonsteroidal anti-inflammatory drug (NSAID)-induced gastropathy and renal insufficiency in the elderly through a structured critical reading of the literature. References were collected through a search of MEDLINE and consultation with experts in the field. While there is an abundance of pharmacokinetic data comparing relevant parameters in young and old subjects, methods are not uniform and findings are inconsistant. Prostaglandin physiology appears to be altered in older versus younger subjects. Most surprisingly, there is a scarcity of epidemiologic data examining the contribution of age as a risk factor for NSAID-induced ulcers and/or renal insufficiency. The data that do exist do not clearly support age as an independent risk factor; and we believe that comorbidities, comedications and past history are more important predictors of NSAID-induced toxicity than age and more relevant in regard to therapeutic decision-making for this patient population.
Nonsteroidal anti-inflammatory drugs and their effects in the elderly
Aging Health, 2012
Management of chronic pain can often be a challenging task, especially in the elderly. Patients over the age of 65 years have altered metabolism and pharmacodynamics that increase their susceptibility to adverse side effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a common component of pain management in this population. Nonselective NSAIDs as well as selective Cox-2 inhibitors have been associated with side effects, including renal dysfunction, heart failure, gastrointestinal toxicity and increased risk of cardiovascular side effects. These adverse effects are particularly important in the elderly, and thus use of NSAIDs in this population must be scrutinized carefully. If NSAIDs are utilized, they should be tailored to the individual patient and administered in the lowest dose and for the shortest duration possible. It is hoped that future studies will provide further insight into the safety of these agents in elderly patients.
Geriatric pharmacotherapy updates
The American Journal of Geriatric Pharmacotherapy, 2007
WHICH NSAIDs HAVE THE MOST FAVORABLE RISK-BENEFIT BALANCE IN OLDER INDIVIDUALS? Researchers evaluated 49,711 Medicare beneficiaries aged ≥65 years who first began therapy with a nonselective NSAID or cyclooxygenase-2-selective inhibitor from 1999 through 2002. Outcomes of interest included the incidence of gastrointestinal (GI) complications and myocardial infarction (MI) within 180 days after drug initiation. Compared with nonselective NSAIDs, celecoxib reduced the risk of GI complications by 1.4 events/100 users but increased the risk of MI by 0.3 event/100 users. Rofecoxib (now withdrawn) decreased GI complications by 1.1 events/100 users and increased the risk of MI by 0.3 event/100 users. When analyzed using celecoxib as the reference exposure, the risk of MI was increased with rofecoxib (risk difference [RD] = 1.40; 95% CI,-0.20 to 3.01) and diclofenac (RD = 6.07; 95% CI,-0.02 to 12.15). The RD for naproxen and the upper boundary of its 95% CI were the lowest among all the NSAIDs (RD =-0.30; 95% CI,-2.74 to 2.14). There were no significant differences in GI complication rates among NSAIDs. Reference Schneeweiss S, Solomon DH, Wang PS, et al. Simultaneous assessment of short-term gastrointestinal benefits and cardiovascular risks of selective cyclooxygenase 2 inhibitors and nonselective nonsteroidal anti-inflammatory drugs: An instrumental variable analysis. Arthritis Rheum.
2019
Introduction: Globally, non-steroidal anti-inflammatory drugs (NSAIDs) usage in the elderly with chronic pain has been reported as frequent. Though it is fundamental in maintaining their quality of life, the risk of polypharmacy, drug interactions and adverse effects is of paramount importance as the elderly usually require multiple medications for their co-morbidities. If prescriptions are not appropriately monitored and managed, they are likely to expose patients to serious drug interactions and potentially fatal adverse effects. Thus, the objective of the study was to assess the appropriateness of NSAIDs use and incidence of NSAIDs related potential interactions in elderly. Methods: A descriptive cross-sectional study was conducted among elderly out-patients (aged 60 and above) who visited three hospitals in Asmara between August 22 and September 29, 2018. The sampling design was two-stage random sampling and data was collected using a questionnaire, exit interview and by abstrac...
Clinical Therapeutics, 1995
Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for the elderly and are commonly prescribed with cytoprotective or antiulcer drugs to prevent or treat gastrointestinal side effects. The objective of this study was to examine the utilization and drug costs of NSAIDs, and to examine coprescription of cytoprotective and antiulcer drugs with NSAIDs in the Nova Scotia population aged 65 years and older. The study used data from the Nova Scotia Seniors Pharmacare program database, which contains data on claims for all filled prescriptions to persons 65 years of age and older. We examined claims for the period April 1, 1993, to March 3 1, 1994. Aspirin accounted for the largest percentage of the total days supply of NSAIDs (25.2%), followed by diclofenac (18.8%) and naproxen (12.9%). Diclofenac accounted for the largest share of expenditures for NSAIDs (27.6%). Overall, 17.1% of the total days supply of NSAIDs were coprescribed with a cytoprotective or antiulcer drug. Histamine, blockers accounted for most coprescribed days supply (83.6%) followed by sucralfate (B.l%), misoprostol(4.5%), and omeprazole (2.3%). The appropriateness and cost-effectiveness of these coprescriptions must be examined.
Therapeutic Advances in Musculoskeletal Disease
Osteoarthritis (OA) is the most common form of arthritis worldwide, and ranges in the top 5–10 most disabling diseases. Contrary to common opinion, this disease is severe, often symptomatic, and may lead to loss of mobility and independence, as well as being responsible for increased frailty and excess mortality [standardized ratio: 1.55 (95% confidence interval, CI: 1.41–1.70)]. The incidence of OA increases dramatically with age in an increasingly ageing world. Therefore, practitioners involved in the management of OA often have to manage very old patients, aged 75–80 years and above, as part of their daily practice. Treatment options are limited. In addition to education and physical treatments, which are at the forefront of all treatment recommendations but require a low level of symptoms to be implemented, many pharmacological options are proposed. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as a second-line treatment but with great caution. However, the precise i...
2013
The incidence of upper gastrointestinal (GI) complications of non-steroidal anti-inflammatory drugs remains the most common side effect. The objective of this study was to compare the incidence of upper gastrointestinal complications of Ibuprofen as non-selective non-steroidal anti-inflammatory drug (NSAID) to Celecoxib and Meloxicam as selective non-steroidal anti-inflammatory drugs. This study included 4 groups of subjects aging above 50 years old divided into control group including 10 healthy volunteers suffering from the symptom of dyspepsia and three test groups, each test group included 10 osteoarthritic or rheumatic patients receiving only one NSAIDs (Ibuprofen, Celecoxib or Meloxicam) from at least 1 month. There was a statistically highly significant difference between the studied groups regarding the incidence of dyspepsia (p-value=0.008) and regarding the incidence of gastritis (p-value=0.042). In group II, there was a statistically significant correlation between the duration of administration of Ibuprofen and the incidence of dyspepsia. Similarly, in group III, there was a statistically significant correlation between the duration of administration of Celecoxib and the incidence of dyspepsia. Controversial, in group IV, there was no statistically significant correlation between the duration of administration of Meloxicam and the incidence of dyspepsia or gastritis or ulcer. Incidence of gastrointestinal side effects was lower for Celecoxib than for Meloxicam than for Ibuprofen. The study concluded that Celecoxib was safer than Meloxicam than Ibuprofen on the upper gastrointestinal tract.
Contraindicated NSAIDs are frequently prescribed to elderly patients with peptic ulcer disease
British Journal of Clinical Pharmacology, 2002
Aims To establish the frequency with which NSAIDs were prescribed to elderly patients after admission to hospital for serious gastrointestinal complications and to study which factors are determinants of the prescription of these contraindicated drugs. Methods A retrospective cohort study of patients from The Rotterdam Elderly Study, a prospective population-based cohort study of people older than 55 years of age was carried out. Elderly patients with a hospital admission for serious gastrointestinal complications were followed until prescription of an NSAID, death, removal to another area or end of the study period, whichever came ®rst. The following baseline determinants for receiving a contraindicated prescription were studied: gender, age, presence of rheumatoid arthritis or osteoarthritis, presence of cardiovascular risk factors, number of GP visits, number of visits to a medical specialist, cognitive function and the prescriber being a GP or a medical specialist. Results Prescriptions of an NSAID after discharge from hospital, were identi®ed in 73 patients (73%). Fifty-one percent were prescribed aspirin of whom the large majority used it as an antithrombotic agent, and 49% were prescribed a nonaspirin NSAID after discharge from hospital. Twenty percent of the patients used more than one NSAID on one or more occasions after discharge. For patients who were prescribed NSAIDs before admission as well as after discharge, the proportion of contraindicated prescriptions with concomitant use of antiulcer drugs rose signi®cantly from 0.19 before discharge to 0.60 after discharge for aspirin and from 0.11 to 0.61 for nonaspirin NSAIDs. In the multivariate analysis the only remaining factor with prognostic in¯uence on prescription of NSAIDs was a history of NSAID use before cohort enrolment. A history of rheumatoid arthritis or osteoarthritis was not associated with NSAID prescription after discharge. Conclusions Contraindicated NSAIDs are prescribed to a great extent in elderly patients, despite their greater vulnerability for life-threatening gastrointestinal blood loss. It is remarkable that a history of rheumatoid arthritis or osteoarthritis is no signi®cant determinant for receiving a contraindicated prescription, which suggests that these drugs are mainly prescribed for uncomplicated arthralgia.