Risks associated with prescription of opioids to older patients

It is important to analyze the risks, diagnose pain, recognize side effects and develop a pain management process that cares for the increased sensitivity and decreased strength and immunity of the elderly instrument.

The main aim of any medical professional would be to treat the ailment along with pain control and an eye on the side effects of the treatment.

With ageing there are pharmacokinetic (time course of drug distribution, absorption, metabolism, and excretion) and pharmacodynamic (the biochemical and physiological effects of drugs and the mechanisms of their actions) changes in elderly. Hence, opioids should be prescribed initially at a lower dose as compared to younger counterparts and opioids like meperidine, propoxyphene, and tramadol should be avoided as far as possible.

Opioids are powerful pain relievers available legally by prescription like codeine and morphine. These drugs interact with opioid receptors on nerve cells in the body and brain. Tramadol is an opioid. It has addictive and over dosage risks like morphine when taken with other painkillers or antidepressants.


Tramadol sold as Ultram and OL-Tram should not be taken by patients taking serotonergic medications or those that have seizures.

It is best to avoid tramadol as far as possible or keep it prescribed to low doses and then keep monitoring it for side effects and pain tolerance. Tramadol is also available online at cheap prices and in stock packages. As it may be difficult for elderly to make frequent visits to a doctor and also some might want to avoid heavy prescription costs, so it is very useful to buy these opioid medications through an online order.The best online pharmacy to buy tramadol like medicines from is a licensed one, one which is tied up to genuine medical practitioners offering prescriptions online.

With ageing , there occur changes in body and so there is an increase in the risks associated with any added prescription. An increase in adipose tissue, decrease in lean body mass, decrease in total body water etc. These changes have a chance at affecting distribution of drug in the body. Drugs that combine with or dissolve in fats and lipids will have greater volume of distribution, and more time to get removed from the body.

Aging can also bring reduction in hepatic blood flow and volume which decreases drug metabolism.

Due to age-related reduction in renal blood flow, there can be changes in the elimination of drugs. The drugs used in elderly get more potent and can take a longer time to act.

It is important to consider what a patient needs and indulge his or her family members in the treatment as far as possible so that when  guidelines for the treatment and prescription routine are laid or when they are educated about opioids, the member can take care of the person to follow the path.

If the pain is controlled, but there are side effects of opioids, then reducing a dose of an opioid will help in getting rid of the side effects like drowsiness, nausea etc. If however, the dose reduction leads to rise in pain, it is advisable to prescribe steroids or lower doses of antidepressants. A treatment that has not been carefully planned with an elderly might result in anxiety, isolation, sleeplessness and depression.

Some of the common problems that are likely to occur during geriatric care are presence of more than one disease along with primary (co-morbidities), poly pharmacy, and increased rate of side effects or treatment failures.

It gets very important for doctors treating these old kids to recognize pain and subtle behaviors even when they cannot or do not want to communicate. There can be a lot of fears about tolerance and risks of dependence on opioids in elderly but a doctor can provide appropriate dosage by understanding the type of pain.

A pain can be nociceptive (pain arising from the stimulation of nerve cells) or neuropathic (Chronic pain resulting from injury to the nervous system (brain and spinal cord) or the peripheral nervous system and then accordingly the doctor can prescribe the correct use of an opioid or any other pain killer.

A doctor needs to monitor around the clock dosing or multiple drug medications, the dosage, pain triggers, drug interactions etc. Patients with moderate to severe pain should be mainly prescribed opioid analgesics. Opioids can be prescribed for both acute as well as chronic pain. In young people, opioids are rapidly absorbed and have a higher rate of first-pass in the liver. However, the rate at which some drugs are absorbed in elderly gets decreased because of lower gastrointestinal transit time and high gastric pH.

It is advisable that one opioid be used instead of many small doses of different opioids. Something that has caused or triggered pain in the past should be avoided. An effort to be more empathetic towards the person will help him communicate freely about his pain and lead to a better treatment.