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Opioid analgesic drugs in the elderly
1Albuquerque Veterans Administration Medical Center, New Mexico, USA.
Clinics in Geriatric Medicine
|August 1, 1996
Summary
Opioid therapy in the elderly requires careful consideration of renal function and metabolite clearance. Adjusting dosage intervals or amounts is crucial, and certain opioids should be avoided due to toxicity risks.
Area of Science:
- Geriatrics
- Pharmacology
- Pain Management
Background:
- Opioid metabolism is crucial for safe administration in the elderly.
- Fear of addiction and tolerance are significant barriers to opioid use.
- Understanding opioid pharmacokinetics in older adults is essential.
Purpose of the Study:
- To review critical aspects of opioid therapy in the elderly.
- To highlight the importance of renal function and metabolite clearance.
- To provide guidance on safe opioid prescribing practices for older patients.
Main Methods:
- Literature review focusing on opioid metabolism, pharmacokinetics, and adverse effects in the elderly.
- Analysis of factors influencing opioid efficacy and safety, including renal function.
- Discussion of specific opioid agents and their suitability for geriatric use.
Main Results:
- Renal function, specifically creatinine clearance, is critical due to renally cleared active metabolites.
- Initiating doses may be similar to younger patients, but longer dosing intervals or smaller doses are often necessary.
- Methadone, propoxyphene, and meperidine are not recommended for the elderly due to metabolite toxicity.
- Constipation is a significant side effect requiring aggressive management with laxatives.
Conclusions:
- Careful monitoring of renal function and appropriate dose adjustments are vital for safe opioid use in the elderly.
- Avoiding specific opioids with toxic metabolites is recommended.
- Future developments aim for more targeted analgesics with fewer side effects.
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