Osteoarthritis (OA) is the most common cause of disability in older adults, and while analgesic use can be helpful its use can also result in adverse drug events.
To review the recent literature to describe potential adverse drug events (ADEs) associated with analgesics commonly used by older adults with OA.
To identify articles for this review, a systematic search of English-language literature (January 2001 – June 2012) was conducted using PubMed, MEDLINE, EBSCO, and the Cochrane Database of Systematic Reviews for publications related to the medical management of osteoarthritis. Searches used a combination of the following search terms: analgesics, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, pharmacokinetics, pharmacodynamics and adverse drug events. We also restricted the search to those papers concerning humans ≥65 years of age. A manual search of the reference lists from identified articles and the authors’ article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that examined analgesic use in older adults.
There are limited data to suggest that non-frail elders are more likely than their younger counterparts to develop acetaminophen-induced hepatotoxicity. However, decreased hepatic Phase 2 metabolism in frail elders may result in an increased risk of hepatotoxicity. Regarding NSAIDs, it is now well-established that older adults are at higher risk for NSAID-induced gastrointestinal toxicity and renal insufficiency. For opioids, the data suggesting an increased risk of falls/fractures/delirium need to be tempered by the potential risk of inadequately treating severe chronic OA pain.
Acetaminophen is the mainstay frontline analgesic for OA pain in older adults. NSAIDs should be limited to short-term use only, and for moderate to severe OA pain, opioids may be preferable in those without substance abuse or dependence issues.
Keywords: aged, osteoarthritis, analgesics, adverse drug events