Adverse Effects of Analgesics Commonly Used by Older Adults With Osteoarthritis: Focus on Non-Opioid and Opioid Analgesics

Abstract

Background 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. Objective To review the recent literature to describe potential adverse drug events (ADEs) associated with analgesics commonly used by older adults with OA. Methods 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. Results 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. Conclusions 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.

Uso de anti-inflamatórios e analgésicos por uma população de idosos atendida na Estratégia Saúde da Família

“…It is known that current guidelines recommend the use of paracetamol as the analgesic of choice for mild to moderate pain caused by osteoarthritis of the knee and hip. 15 In patients for whom acetaminophen does not contain adequate analgesia or has little anti-inflammatory effect, NSAIDs are recommended. 38 Polypharmacy was directly linked to the use of anti-inflammatories and analgesics.…”

“…10 Brazilian studies report that self-medication with analgesics is a common occurrence among the elderly, as the use of such medication is related to the treatment of pain and inflammation, common symptoms for this age group. [11][12][13] The American Geriatrics Society Panel on Persistent Pain among the Elderly 14 found that non-opioid analgesics are the most widely used drugs for pain management, although studies 12,14,15 have found an increase in the use of opioid analgesics in Europe and North America. Opioid analgesics provide an analgesia for moderate to severe pain, but should be used with caution as they can cause constipation, respiratory depression and dellirium.…”

“…The use of NSAIDs among the elderly is associated with a high risk of gastrointestinal toxicity and renal failure, as well as being related to cardiovascular events and countless drug interactions. 15 The American Geriatrics Society suggests that paracetamol should be prescribed prior to the use of oral anti-inflammatory medications. However, it is known that paracetamol possesses a toxic metabolite that can accumulate in the liver, and should therefore be prescribed in lower doses for the elderly and for patients with liver disease.…”

“…However, it is known that paracetamol possesses a toxic metabolite that can accumulate in the liver, and should therefore be prescribed in lower doses for the elderly and for patients with liver disease. 14,15 Anti-inflammatory drugs should generally be avoided in elderly patients, especially those with peptic ulcers, chronic liver or heart disease or hypertension, and individuals using drugs with antiplatelet action, such as aspirin, corticosteroids or selective serotonin reuptake inhibitors. 16,17 Many studies have indicated that the prevalence of prescribing drugs that interact with each other for patients using anti-inflammatories is very high, and of considerable concern.…”

Caracterización de reacciones adversas a medicamentos en adultos mayores de 44 años en Bogotá, D.C., enero - diciembre de 2012

“…Aunque estos fármacos son eficaces para controlar el dolor y la inflamación causados por dichas enfermedades, también generan reacciones adversas graves, entre ellas, la hemorragia digestiva, la cual encabeza la lista de causas de hospitalización por reacciones adversas a medicamentos en adultos mayores a nivel mundial. En este estudio, los antinflamatorios no esteroideos ocuparon el segundo lugar con el 12 % de dichos reportes en Bogotá (23)(24)(25).…”