Table 3.

When prescribing opioids in older adults

Beginning at the lowest possible dose and titrating upwards base on tolerability and efficacy

Longer dosing interval and regular monitoring are recommended

Switching to another opioid might be indicated in cases of unacceptable side effects of insufficient analgesia

The oral route may be the most convenient

Low-doses of strong opioids should be preferred to weak opioids because of its effectiveness and safety

Strong opioids generally recommended in frail old population are buprenorphine, hydromorphone and oxycodone (including oxycodone/naloxone formulation)

Controlled-release formulation and transdermal formulations are generally preferred (low risk of addiction and adverse effects)

Considering laxatives or oxycodone/naloxone to prevent constipation

Over-the-counter analgesics use should be avoided