Nonsteroidal anti-inflammatory drug toxicity: increased risk in the elderly

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the therapy of rheumatic diseases, especially in older patients. The toxicity profile of NSAIDs includes gastrointestinal (GI) toxicity, renal dysfunction and hepatic disease. Altered drug pharmacology in older patients may be a factor in their increased risk for drug toxicity. Elderly patients appear to be at greatest risk for symptomatic GI toxicity, including ulceration and even major GI bleeding. Central nervous system toxicity, characterized by dizziness, headaches, mood alteration and confusion, and renal dysfunction have also been reported to occur more commonly among elderly patients. Hepatic dysfunction is a rare NSAID-induced toxicity, but older patients are often at greatest risk for serious hepatic disease. Understanding the patient's underlying physiologic condition, concomitant drug therapy and the kinetics of the NSAID being used is critical to the safe administration of these agents to elderly individuals.