Renal and hepatic effects of NSAIDs in the elderly

Adverse drug reactions are more common in patients over sixty-five years of age. There is no significant change of absorption with aging but oxidations reactions are, usually, decreased. The most important change is in the renal elimination of drugs. The renal insufficiency related to the use of NSAIDs is prostaglandin dependent. It is characterized by a fall in urine output, body weight gain, rising of blood urea nitrogen, creatinine and, sometimes, potassium. This situation is usually rapidly reversible after discontinuation of the therapy but an acute renal failure may occur. Patients with atherosclerotic cardio-vascular disease and concurrent diuretic therapy have an increased risk of renal insufficiency. Liver damage induced by NSAIDs presents as an acute hepatitis with a greater or lesser degree of cholestasis. This picture is often indistinguishable from viral hepatitis and sometimes it may resemble chronic active hepatitis. Females with a concomitant impairment of renal function are specially at risk for liver damage and should be carefully followed on with a reduction of NSAIDs dosage.