NSAIDs and the elderly : Toxicity and economic implications

Despite their propensity to cause toxicity, nonsteroidal anti-inflammatory drugs (NSAIDs) are routinely prescribed for older patients for painful musculoskeletal conditions, many of which are noninflammatory in nature. In some settings, simple analgesia with paracetamol (acetaminophen) or tramadol m...

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Bibliographic Details
Published in:Drugs & aging 1997-02, Vol.10 (2), p.119-130
Main Authors: PHILLIPS, A. C, POLISSON, R. P, SIMON, L. S
Format: Article
Language:English
Subjects:
Aged
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Anti-Inflammatory Agents, Non-Steroidal - economics
Anti-Ulcer Agents - therapeutic use
Biological and medical sciences
Costs and Cost Analysis
Drug toxicity and drugs side effects treatment
Female
Gastrointestinal Diseases - chemically induced
Gastrointestinal Diseases - prevention & control
Humans
Kidney Diseases - chemically induced
Kidney Diseases - physiopathology
Kidney Diseases - prevention & control
Male
Medical sciences
Miscellaneous (drug allergy, mutagens, teratogens...)
Misoprostol - therapeutic use
Pharmacology. Drug treatments
Risk Factors
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Summary:Despite their propensity to cause toxicity, nonsteroidal anti-inflammatory drugs (NSAIDs) are routinely prescribed for older patients for painful musculoskeletal conditions, many of which are noninflammatory in nature. In some settings, simple analgesia with paracetamol (acetaminophen) or tramadol may be just as effective as NSAIDs. The benefits of therapy with NSAIDs must be weighed against their potential risks. With the anticipated growth of the elderly population, the economic implications of NSAID use in older patients are staggering. Estimates of the total cost of prescribing NSAIDs to the elderly must include the additional costs of gastroprotective agents, prophylaxis, laboratory monitoring, physician evaluations and interventions for adverse effects. Misoprostol may be cost effective as primary prophylaxis of NSAID-induced ulcer disease in some elderly patients. NSAIDs may reduce disability and improve quality of life, thereby offsetting their costs. To date, the direct, indirect and intangible cost of NSAIDs and cost offsets have not been systematically evaluated in the elderly. At this juncture, NSAIDs may be used judiciously in older patients, and misoprostol should be considered in high risk patients. Further studies to assess the economics of NSAIDs in the elderly population are warranted.
ISSN:1170-229X
1179-1969
DOI:10.2165/00002512-199710020-00005