Arthritis drugs and the older patient
It is this age group that is most prone to developing adverse drug events or ADEs. ADEs occur as a result of four major factors:
• Drug interaction • Interaction between drugs and nutritional supplements • Functional changes associated with aging • Age-related disease
The use of multiple medications increases the risk of ADEs.
Medications are handled differently by the body as a person ages. Alterations occur in drug absorption, distribution in the body, metabolism, and excretion.
Among the more important changes that occur in the body are an increase in body fat, decrease in lean body mass, and decrease in total body water.
As patients get older, changes in liver and kidney function occur. It becomes more difficult for the body to eliminate drugs that are normally excreted by the kidneys.
Liver size and blood flow also decrease. This can lead to greater drug effect if metabolism of the drug is delayed.
Changes in drug receptors also can lead to increased drug effect and potential side effects.
In patients who require medicines for arthritis, particularly non steroidal anti- inflammatory drugs (NSAIDS), this can be particularly hazardous. Age is a major risk factor for the development of kidney failure, gastrointestinal bleeding, high blood pressure, and heart failure. Muscle relaxants sometimes prescribed for muscle strain can cause excessive side effects as well.
The bottom line is to use the least amount and the least number of medicines needed to manage the problem. And in patients taking multiple medications, the caution required for monitoring is increased.
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