Are Over-the-Counter Anti-inflammatory Pain Relievers Safe for Older Adults?

A fellow caregiver asked...

Are over-the-counter anti-inflammatory pain relievers, like ibuprofen, safe for older adults?

Expert Answer

Dr. Leslie Kernisan is the author of a popular blog and podcast at BetterHealthWhileAging.net. She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

Ibuprofen (brand names Advil, Motrin) and other nonsteroidal anti-inflammatory drugs (NSAIDs) can be unsafe for many older adults, especially when taken daily. Geriatricians much prefer that older adults take acetaminophen (Tylenol), because it causes almost no side effects and only rarely interacts with other medications a person may be taking.

Although ibuprofen is popular with arthritis sufferers because it's effective at relieving pain, older adults should talk to a healthcare provider before taking any NSAIDs. This includes newer OTC painkillers such as naproxen (Aleve) and stronger prescription-strength NSAIDs such as celecoxib (Celebrex) and indomethacin (Indocin).

NSAIDs are well known for having the following side effects in older adults:

  • Decreased kidney function as a result of decreased blood flow to the kidneys. This can affect the way the body processes other medicines and can increase blood pressure.
  • Irritation of the lining of the stomach and bowels, which can cause internal bleeding.

Every year literally tens of thousands of people, mostly elderly, are hospitalized because of NSAIDs.

Older adults who strongly prefer ibuprofen to acetaminophen should talk to the doctor and ask for a kidney function test. Mild to moderate decreases in kidney function usually do not cause symptoms but can be detected with a blood test.

Also, most older adults should avoid the "PM" version of ibuprofen (Advil), acetaminophen (Tylenol), or any other over-the-counter medicine. Why? These medicines contain sedating antihistamines such as diphenhydramine (also known as Benadryl) and doxylamine. Sedating antihistamines are part of a class of medicines known as anticholinergics. They do make you sleepy, but in older folks they can also cause constipation, dry mouth, difficulty urinating, and confusion. Older adults who take anticholinergics also are known to fall more often.

These medicines can be especially dangerous for people with Alzheimer's or other forms of dementia, since anticholinergics counter the effect of medicines such as donepezil (Aricept).