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

被引:125
作者
Barkin, Robert L. [1 ,2 ,3 ,4 ]
Beckerman, Mihail [5 ]
Blum, Steven L. [5 ]
Clark, Frank M. [6 ]
Koh, Eun-Kyu [6 ]
Wu, Dickson S. [5 ]
机构
[1] Rush Univ, Med Ctr, Dept Anesthesiol, Chicago, IL 60612 USA
[2] Rush Univ, Med Ctr, Dept Family Med, Chicago, IL 60612 USA
[3] Rush Univ, Med Ctr, Dept Pharmacol, Chicago, IL 60612 USA
[4] Skokie & Evanston Hosp, N Shore Univ Hlth Syst Pain Ctr, Dept Anesthesiol, Skokie, IL USA
[5] Skokie Hosp, N Shore Univ Hlth Syst Pain Ctr, Skokie, IL USA
[6] Evanston Hosp Corp, N Shore Univ Hlth Syst Pain Ctr, Evanston, IL USA
关键词
DICLOFENAC SODIUM GEL; OXIDE DONATOR NAPROXCINOD; PEPTIC-ULCER DISEASE; TOPICAL DICLOFENAC; DOUBLE-BLIND; CHRONIC PAIN; CYCLO-OXYGENASE-2; INHIBITORS; COX-2; CYCLOOXYGENASE-2; INHIBITION; GASTROINTESTINAL TOXICITY;
D O I
10.2165/11539430-000000000-00000
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
030301 [社会学]; 100201 [内科学];
摘要
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 cyclooxygenase (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.
引用
收藏
页码:775 / 789
页数:15
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