Which pain medication should be avoided in older adult patients with fractures?

Meperidine should be avoided in older adult patients with fractures due to its potential for toxicity and adverse effects in this population. Meperidine, an opioid analgesic, has a unique pharmacokinetic profile; it produces a metabolite called normeperidine, which can accumulate in patients with renal impairment, a common issue among the elderly. Accumulation of this metabolite can lead to central nervous system excitability, seizures, and increased risk of adverse effects, making it particularly risky for older adults who often have comorbidities and polypharmacy.

In contrast, other analgesics listed have more favorable safety profiles or are used more extensively in older patients. Oxycodone and morphine are still used in older adults but should be prescribed cautiously, taking into account individual patient needs and potential side effects. Acetaminophen is generally considered safer for pain management in older adults, especially when not contraindicated by liver conditions or polypharmacy.

Consequently, in the context of managing pain in older adults with fractures, meperidine poses significant risks that outweigh its benefits, making it essential to avoid its use.