Acetaminophen increases risk for hypertension, GI bleeding in patients 65 years and older
Key takeaways:
- Acetaminophen exposure increased risks for cardiovascular and gastrointestinal complications in patients aged 65 years and older.
- There was a dose-response relationship with chronic renal failure and other effects.
Patients aged 65 years and older who use acetaminophen demonstrate greater risks for serious complications, including hypertension, chronic kidney disease and gastrointestinal bleeding, noted a study published in Arthritis Care & Research.
“Almost all clinical guidelines advocate acetaminophen as the first-line oral pharmacological treatment for pain due to osteoarthritis, mainly because of its perceived safety over other oral analgesics,” Jaspreet Kaur, BAMS, MPH, PGDip, PhD, a research fellow at the University of Nottingham, in the United Kingdom, and colleagues wrote. “However, recent studies have raised concerns that acetaminophen may be not as safe as previously thought.
“It is still unclear whether individuals prescribed acetaminophen are at increased risk of developing gastrointestinal, cardiovascular and renal adverse events compared with those not taking any analgesics,” they added.
To learn more about the risks for serious complications that may come with acetaminophen use, Kaur and colleagues conducted a population-based cohort study using Clinical Practice Research Datalink-Gold, a large U.K. health care database. The analysis included data for 180,483 participants aged 65 years and older who had received at least two acetaminophen prescriptions within 6 months, between January 1998 and January 2018. These patients were matched with 402,478 “unexposed” individual who received fewer than two prescriptions in 6 months. Follow-up began 12 months after their first prescription date.
Hazard ratios for various complications were calculated using a Cox regression model with inverse probability treatment weighting and propensity score.
According to the researchers, acetaminophen exposure demonstrated increased risks for multiple severe complications, including:
- perforation, ulceration or bleeding (adjusted HR = 1.24; 95% CI, 1.16-1.34);
- uncomplicated peptic ulcers (adjusted HR = 1.2; 95% CI, 1.1-1.31);
- lower gastrointestinal bleeding (adjusted HR = 1.36; 95% CI, 1.29-1.46);
- heart failure (adjusted HR = 1.09; 95% CI, 1.06-1.13);
- hypertension (adjusted HR = 1.07; 95% CI, 1.04-1.11); and
- chronic kidney disease (adjusted HR = 1.19; 95% CI, 1.13-1.24).
The analysis also revealed dose-response relationships, the researchers wrote. For example, increasing the number of prescriptions raised the risks for perforation, ulceration or bleeding; uncomplicated peptic ulcers; and chronic renal failure.
“These data further challenge whether acetaminophen should be retained as the first-line oral analgesic, especially in older people for common chronic painful conditions, given its non-clinically meaningful benefits and potential harms, and support the recent recommendation by [the National Institute for Health and Care Excellence] not to prescribe acetaminophen for OA,” Kaur and colleagues concluded. “A study in which acetaminophen prescription is modeled as a time-varying exposure should be undertaken to confirm these findings.”
Perspective
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As an advanced practice provider in an adult rheumatology practice, it is essential to be aware of the potential increased risks associated with medications in the elderly population, especially when selecting pain management options.
Although acetaminophen has long been considered a first-line analgesic due to its perceived safety, this study’s evidence of increased risks for gastrointestinal bleeding, cardiovascular complications and chronic kidney disease necessitates a more cautious approach.
As a provider, the challenge lies in balancing the benefits of pain relief with the potential adverse effects, especially in geriatric patients who often present with multiple comorbidities and polypharmacy issues. This research reinforces the importance of personalized medicine — considering alternative therapies such as nonpharmacologic pain management, topical NSAIDs, or multimodal strategies while closely monitoring patients who require long-term acetaminophen use.
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