NSAIDs

NSAID use in Geriatrics

By: Joanne Jansen PharmD and Anjanette Dymerski PharmD

NSAID - Be cautious when using NSAIDs (naproxen, ibuprofen, celecoxib, meloxicam) if you have high blood pressure and heart conditions. NSAIDs can significantly raise blood pressure, retain sodium, and impede kidney function.
What are NSAIDs?
  • NSAIDs, or nonsteroidal anti-inflammatory drugs, are medications used to relieve mild to severe pain.

How are NSAIDs available?
  • Some NSAIDs are available over the counter (OTC), while others are prescription only. There are also topical and oral products.
  • Topical forms are used to treat pain in the area to which it is applied (ie the knee) while oral forms can be used to treat most pains anywhere in the body.

What are some of the most commonly used NSAIDs?
  • OTC
  • Ibuprofen (Advil®, Motrin®)
  • Naproxen (Aleve®)
  • Aspirin
• Prescription Only
  • Indomethacin (Indocin®)
  • Ketoprofen
  • Naproxen (Naprosyn®)
  • Meloxicam (Mobic®)
  • Diclofenac (Voltaren®)
  • Oxaprozin (Daypro®)
  • Celecoxib (Celebrex®)
  • Piroxicam (Feldene®)

What is the difference between acetaminophen (Tylenol®) and NSAIDs?
  • Tylenol is a pain reliever and fever reducer, however it does not decrease inflammation.
  • NSAIDs relieve pain, reduce fever, and reduce inflammation.

What are the risks associated with oral NSAIDs?
  • In general, NSAIDs are not recommended in patients over 65 year old.
  • Bleeding risks: stomach ulcers are very common.
It is very important to take NSAIDs with food.
  • Kidney risks: NSAIDs can cause your kidneys to become less efficient.
  • Heart risks: NSAIDs can increase blood pressure, contribute to heart failure, and also increase the risk for other heart problems.
  • Because of these potentially severe risks, it is very important to ask your doctor or pharmacist if NSAIDs, even OTC, are safe for you before taking them.

What topical products are available?
OTC
  • Trolamine salicylate (Aspercreme®)
  • Methyl Salicylate (Bengay®, IcyHot®)
Prescription only
  • Diclofenac (Voltaren® gel, Flector® patch)
Prescription only, but must be made at a compound pharmacy
  • Ketoprofen gel
  • Ibuprofen gel

Are there any risks associated with topical NSAIDs?
  • In general, topical NSAIDs are fairly safe.
  • Skin rashes where the topical NSAID is applied is the most common side effect.
  • Ulcers and heart problems can sometimes occur though, especially when applied to large areas of skin.

Federal Drug and Food Administration U.S. Public Health Service. Proposed NSAID package insert labeling. J pain Palliat Care Pharmacother 2006;20(1):49-55.

Micromedex ™ [database on the internet]. 10 Nov 2009 [cited 2009]. Available from: http://www.thomsonhc.com/home/dispatch.

Dubois RW, Melmed GY, Henning JM, Laine L: Guidelines for the appropriate use of non-steroidal anti-inflammatory drugs, cyclo-oxygenase-2-specific inhibitors and proton pump inhibitors in patients requiring chronic anti-inflammatory therapy. Aliment Pharmacol Ther 2004;19:197-208.