Therapeutic Choices for Rheumatic Disorders

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Abstract
Of concern to physicians specializing in the elderly is the different profile of drug metabolism and toxicity in the elderly. Older patients have differences in metabolism of a number of drugs, as well as in altered immunologic responses to these agents. The advantages and disadvantages of the agents used most frequently to treat elderly rheumatic patients will be reviewed. For example, effects of various nonsteroidal antiinflammatory drugs (NSAIDs) regarding efficacy and adverse gastrointestinal, hepatic, and renal effects, and their different pharmacokinetic profiles can play a part in choosing appropriate therapy for an individual patient. Etodolac, a newer NSAID, is a promising addition to the available choices for elderly, as well as younger, patients. Etodolac has been shown to be clinically effective with a low incidence of adverse effects. It has a half-life of approximately 7 h in older patients, and about 75% of the drug is excreted in the urine mainly as metabolites. It is highly protein-bound.

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