Nonsteroidal anti-inflammatory drugs in the elderly

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in the elderly for the treatment of fever, pain, pain associated with inflammation in rheumatoid arthritis and osteoarthritis, neuromuscular disorders, headache, and musculoskeletal conditions. Each year in the United States, people spend 5 to 10 billion dollars to purchase prescription and over-the-counter NSAIDs. Gastrointestinal side effects such as ulcers and bleeding are the most prevalent and life-threatening problems associated with NSAIDs. Specifically in the elderly, NSAIDs have become a leading cause of hospitalization and may increase the risk of death from ulceration more than 4-fold. NSAIDs and the new class of cyclo-oxygenase-2 selective NSAIDs continue as drugs of choice for analgesia and anti-inflammatory effects. Physiological changes of aging worsen the side-effect profile of NSAIDs in the elderly. These side effects, when added to the increased potential for drug interactions, lead to a much greater risk for adverse outcomes when NSAIDs are used in the elderly patient. The similarities and differences in the NSAID agents warrant review in light of the newer drugs--celecoxib and rofecoxib--with their expected improvement in gastrointestinal side effects. This article reviews current information about using NSAIDs in elderly persons.