Toxicity of nonsteroidal anti-inflammatory drugs in the elderly: is advanced age a risk factor?

We reviewed the pharmacokinetic, physiologic and epidemiologic data concerning nonsteroidal anti-inflammatory drug (NSAID)-induced gastropathy and renal insufficiency in the elderly through a structured critical reading of the literature. References were collected through a search of MEDLINE and consultation with experts in the field. While there is an abundance of pharmacokinetic data comparing relevant parameters in young and old subjects, methods are not uniform and findings are inconsistent. Prostaglandin physiology appears to be altered in older versus younger subjects. Most surprisingly, there is a scarcity of epidemiologic data examining the contribution of age as a risk factor for NSAID-induced ulcers and/or renal insufficiency. The data that do exist do not clearly support age as an independent risk factor; and we believe that comorbidities, comedications and past history are more important predictors of NSAID-induced toxicity than age and more relevant in regard to therapeutic decision-making for this patient population.