Non opioid pharmacological agents for the elderly

What non opioid pharmacological agents are available for the elderly?

Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common non-opioid pain medications prescribed. Acetaminophen potentiates the effects of opioids and is therefore a useful co-analgesic; however, it does have a ceiling effect, and therefore dose escalation is limited. It is metabolized by the liver and excreted by the kidneys, and therefore caution must be taken in cases of altered liver/kidney function. The maximum recommended dose for the elderly is 2000 mg a day. Overall, acetaminophen is considered a safe drug with demonstrated effectiveness and should be used as a first line as well as ongoing medication if not contraindicated.

NSAIDs, on the other hand, are considered high risk for cardiac, gastrointestinal, and renal side effects, drug-disease, and drug-drug interactions in the elderly, and should therefore be avoided in long-term management. Effects include dose- and time-dependent increased risk for GI bleeding and ulcers, renal vasoconstriction, and increased tubular sodium reabsorption, contributing to hypertension, fluid retention, renal failure, myocardial infarcts, and heart failure. If NSAIDs are to be used, topical NSAIDs are preferred; however, if systemic NSAIDs are used, a proton pump inhibitor is suggested for gastrointestinal protection.


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