Selective inhibitors of cyclooxygenase-2. Potential in elderly patients

Nonsteroidal anti-inflammatory drugs (NSAIDs) are extensively used as anti-inflammatory and analgesic agents in the elderly, as well as for their anti-thrombotic properties. In the future, NSAIDs may be more widely used in this sector of the population for the prevention of colon cancer. However, the elderly demonstrate a particularly high incidence of adverse reactions to this class of compounds. The factors responsible for this differential toxicity involve age-related pharmacokinetic, pharmacodynamic and physiological factors, as well as coincident disease states and polypharmacy. Selective inhibitors of cyclooxygenase-2 form a novel class of anti-inflammatory drugs that, in animal studies, exhibit significantly fewer adverse effects on the gastrointestinal tract than standard NSAIDs. If this proves to be the case in humans, these novel agents may be useful for the treatment of inflammation and pain as well as in colorectal cancer prevention, but they will not have utility as antithrombotic agents.