Can older people safely take opioids, such as hydrocodone and oxycodone, to manage arthritis pain?

Answers 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.

Sep. 20, 2011 See more Expert Answers