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Abstract
Drugs without a strong evidence base and outside of recommendations are too often
prescribed for older adults. Established guidelines such as Beers criteria have identified
both specific medications and certain drug classes as inappropriate for older adults,
primarily due to adverse effects. Age-related physiological changes in distribution,
metabolism, and elimination often alter the effects of pharmacotherapies in older
adults. When designing a therapeutic program, all elements contributing to the pathophysiology
of painful conditions should be considered, as well as the mechanisms of action of
analgesic drug classes. Both appropriate and inappropriate medications for older adults
are detailed herein, as well as their contraindications and potential drug-drug or
drug-disease interactions. The number needed to treat (NNT) can be useful in considering
efficacy, while the safety of a pharmacotherapy is indicated by the calculated number
needed to harm (NNH). The NNT is a measure describing the number of patients who require
treatment for every 1 who reaches the therapeutic goal, and the NNH describes the
number of participants who manifest side effects; these can further be segregated
into numbers who withdraw from studies due to intolerable side effects. These parameters,
along with a patient's comorbidities and concomitant medications, should be considered
when selecting an analgesic and dose regimen. In addition, practitioners should avoid
prescribing multiple-drug therapies that have overlapping pharmacodynamics or that
may have an adverse pharmacokinetic interaction.