Department of Clinical Pharmacy, School of Pharmacy, University of California at San Francisco, San Francisco, California 94143-0622, USA.
J Pain. 2011 Mar;12(3 Suppl 1):S21-9. doi: 10.1016/j.jpain.2011.01.001.
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.
没有强有力证据基础且不在推荐范围内的药物，在治疗老年人时往往被过度使用。已建立的指南，如 Beers 标准，已经确定了一些特定的药物和某些药物类别不适合老年人，主要是因为它们会产生不良反应。与年龄相关的分布、代谢和消除的生理变化，常常改变了老年患者药物治疗的效果。在设计治疗方案时，应考虑导致疼痛状况的病理生理学的所有因素，以及各种类别的镇痛药物的作用机制。本文详细介绍了适合和不适合老年人使用的药物，以及它们的禁忌证和潜在的药物-药物或药物-疾病相互作用。需要治疗的人数（NNT）可用于评估疗效，而药物治疗的安全性则由计算得出的需要造成伤害的人数（NNH）来表示。NNT 是一个描述每治疗 1 个患者达到治疗目标，需要治疗的患者人数的指标，NNH 描述了出现副作用的参与者人数；这些还可以进一步分为由于无法耐受的副作用而退出研究的人数。在选择镇痛药和剂量方案时，这些参数以及患者的合并症和伴随用药，都应加以考虑。此外，医生应避免开具具有重叠药效学或可能存在不良药代动力学相互作用的多药物疗法。
