Article Abstract:
Nonsteroidal anti-inflammatory agents, also called NSAIDs, are commonly used for the treatment of rheumatologic conditions such as arthritis. The elderly have an increased risk for these conditions and are among the highest users of this group of medications. NSAID-associated kidney dysfunction is a particular concern in the elderly, who because of their age may already have reduced kidney function. Patients residing in long-term care facilities, such as nursing homes, usually have several chronic diseases and receive multiple medications. This study was designed to determine the frequency and risk for NSAID-associated azotemia, a condition caused by failure of the kidneys to remove excess waste products, such as urea, from the blood. For this study, azotemia was defined as a greater than 50 percent increase in the serum urea nitrogen (SUN) level over the original amount, or the baseline level. Elderly patients that were receiving an NSAID for at least five days were studied and their kidney function was assessed by laboratory testing, which included measurement of SUN. A total of 114 patients who received an NSAID (primarily ibuprofen) were studied. Patients who received an NSAID had a significant elevation in SUN levels when compared with patients who did not receive a drug of this category. Fifteen patients met the definition for azotemia and had SUN levels up to 89 percent over baseline. Elderly patients who have additional risks for development of azotemia, including use of other drugs, should be cautiously given NSAIDs. The lowest possible effective dose should be given for the shortest time necessary to achieve the desired result. For an elderly patient requiring more than just a few days of treatment with an NSAID, laboratory monitoring should include measurement of SUN levels. Continued use of an NSAID in an elderly patient should be based on the results of this testing. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Many elderly patients on metoclopramide are also receiving levodopa because their doctors mistakenly believe the side effects of metoclopramide are actually symptoms of Parkinson's disease. Metoclopramide is used in some gastrointestinal diseases and also as an anti-vomiting drug in people taking chemotherapy. Researchers used a New Jersey Medicaid pharmacy claims database to analyze the odds of an elderly person taking levodopa, which is a treatment for Parkinson's disease, and metoclopramide simultaneously. A total of 1,253 elderly people were started on levodopa between 1981 and 1990. They were three times more likely to have used metoclopramide recently than a group of 16,435 elderly people who were not taking anti-Parkinson's drugs. The odds of taking levodopa increased as the dose of metoclopramide increased. Metoclopramide has side effects that could be mistaken as Parkinson's disease.
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Elderly individuals and women may be less likely to be included in clinical trials of drugs to treat heart attacks than other individuals. Clinical trials are research studies that test new drugs in human volunteers before Food and Drug Administration approval. A survey of 214 clinical trials of drugs to treat heart attacks between Jan 1960 and Sep 1991 found that 130 studies (60.7%) excluded patients based on age. Forty-four studies excluded patients over 75 years old and 67 excluded patients over 70 years old. Elderly individuals were less likely to participate in studies published after 1980 than in those published before 1980. Ten studies excluded women completely, and 16 excluded women of childbearing age. In studies that excluded certain individuals based on age, 18% of the participants were women, compared with 23% in studies without age-based exclusion.
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