Drugs

Elderly patients are among those who appear predisposed to NSAID-induced gastrointestinal bleeding (Carson et al., 1987). A case-controlled study by Collier and Pain (1985) found a twofold increase in risk of perforated peptic ulcer in patients over 65 years, whereas the risk was not increased in those under 65. Although all NSAIDs may be implicated, ibuprofen and diclofenac carry the lowest risk and azapropazone and ketoprofen the highest (Langman et al., 1994). Elderly people are also at increased risk of other ADRs from NSAIDs including hyper-kalaemia, fluid retention and nephrotoxicity (Blackshear et al., 1983). A prospective study of elderly residents in a large nursing home who were started on NSAIDs demonstrated a deterioration in renal function in 13% over a short course of therapy (Gurwitz et al., 1990). This adverse effect was associated with higher NSAID doses and concomitant use of loop diuretics. The elderly are also at risk from central nervous system effects such as headaches and giddiness (O'Brien and Bagby, 1985).

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