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Opioids: Safe for older people?By Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/opioids/AN02009
- With Mayo Clinic geriatrician
Paul Y. Takahashi, M.D.read biographyclose window
Paul Y. Takahashi, M.D.Paul Y. Takahashi, M.D.
"The Internet will impact the lives of all patients young and old. Older and mature patients are no exception to this information explosion." — Dr. Takahashi
Dr. Paul Yoshio Takahashi works with elderly patients as a member of the geriatric consultative group at Mayo Clinic. He works in all medical settings, including the outpatient clinic, the nursing home and occasionally the patient's home. He is especially interested in strategies for successful aging, preventing elder abuse and mistreatment, home telemonitoring, frailty, and cognitive screening in elderly patients.
Dr. Takahashi is a consultant in the Division of Primary Care Internal Medicine at Mayo Clinic. He is an associate professor of medicine at College of Medicine, Mayo Clinic, and a fellow of the American College of Physicians. He had a fellowship in geriatric medicine at Mayo Graduate School of Medicine from 1997 to 1998.
Dr. Takahashi cares for all of a patient's acute needs and chronic problems and focuses on specialty issues such as memory problems, safety in the home, healthy aging, proper medications and end-of-life concerns.
He sees the Internet playing a growing role in the health information field.
"Patients and their families want and expect the most up-to-date information about life, health, disease and death. Healthy aging as a concept has grown quickly over the last 20 years as we have all lived longer and hopefully better," he says. "I expect that Mayo Clinic will be a significant part of this growing movement of a healthy maturity."
Dr. Takahashi, a native of Pittsfield, Ill., joined Mayo Clinic in 1998 and is board certified in internal medicine with added qualification in geriatric medicine. He is a fellow of the American Geriatrics Society.
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Opioids: Safe for older people?
Can older people safely take opioids, such as hydrocodone and oxycodone, to manage arthritis pain?
from Paul Y. Takahashi, M.D.
In general, older people can take opioids safely. But an opioid isn't the first choice for treating chronic joint pain caused by osteoarthritis. Instead, acetaminophen (Tylenol, others) is recommended as the first line medication for older people with mild to moderate arthritis pain.
Opioids have risks that may be particularly serious for older people, including:
- Sedation, increasing the risk of falls
- Development of tolerance and possible addiction
- Overmedication because the body processes drugs more slowly with age
- Unpredictable interactions between opioids and any of several other medications older people may also take
Acetaminophen is effective and generally safe, although high doses can cause serious liver damage. The adult dose of over-the-counter acetaminophen is 325 to 660 milligrams (mg) every four to six hours, never to exceed a total of 4 grams within any 24-hour period. Because older people metabolize drugs less efficiently, they tend to do well with doses at the low end of that range. If you drink heavily, have alcohol-related liver damage or have a history of any kind of liver disease, don't exceed a total of 2 grams of acetaminophen in a day.
Also, if you're taking a prescription pain medication that contains acetaminophen and an opioid, don't take any additional over-the-counter acetaminophen. Examples of these combination drugs include codeine and acetaminophen (Tylenol with codeine), oxycodone and acetaminophen (Percocet, Roxicet), and hydrocodone and acetaminophen (Vicodin, Norco).
Older people should avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), for osteoarthritis pain. Recent studies have found high rates of bleeding in the digestive tract among older people on NSAID therapy. Worsening of heart failure and increased risk of kidney disease are other problems linked to chronic NSAID use in older people.Next question
Hip resurfacing: An alternative to conventional hip replacement?
- Ickowitz E, et al. Pharmacological management of persistent pain in older persons. American Geriatrics Society panel on the pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society. 2009; 57:1331.
- Barber JB. Treatment of chronic non-malignant pain in the elderly: Safety considerations. Drug Safety. 2009;32:457.
- Takahashi PY (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 1, 2011.
- Zhang W, et al. Does paracetamol (acetaminophen) reduce the pain of osteoarthritis? A meta-analysis of randomised controlled trials. Annals of Rheumatic Diseases. 2004;63:901.
- Wegman A, et al. Nonsteroidal antiinflammatory drugs or acetaminophen for osteoarthritis of the hip or knee? A systematic review of evidence and guidelines. Journal of Rheumatology. 2004;31:344
- Acetaminophen. Micromedex Healthcare Series. http://www.micromedex.com. Accessed Sept. 1, 2011.
- FDA drug safety communication: Prescription acetaminophen products to be limited to 325 mg per dosage unit; boxed warning will highlight potential for severe liver failure. http://www.fda.gov/Drugs/DrugSafety/ucm239821.htm. Accessed Sept. 2, 2011.
- Tylenol with codeine (prescribing information). Raritan, N.J.: Ortho-McNeil-Janssen Pharmaceuticals, Inc.; 2011. http://www.janssen-ortho.com/JOI/pdf_files/tylenol_E.pdf. Accessed Sept. 5, 2011.
- Percocet (prescribing information). Chad's Ford, Pa.: Endo Pharmaceuticals, Inc.; 2011. http://www.endo.com/pdf/products/Percocet_pack_insert_2.pdf. Accessed Aug. 25, 2011.
- Vicodin (prescribing information). North Chicago, Ill.: Abbott Laboratories; 2011. http://www.rxabbott.com/pdf/vicodin.pdf. Accessed Aug. 25, 2011.