Which analgesic listed is inappropriate for older adults due to GI bleed risk and AKI?

• A. Naproxen
• B. Indomethacin
• C. Acetaminophen
• D. Tramadol

Answer: (B)

Prostaglandins help protect the stomach lining and keep kidney blood flow stable. Nonsteroidal anti-inflammatory drugs (NSAIDs) block COX enzymes, lowering prostaglandin levels and increasing the risk of gastric ulcers/bleeding and acute kidney injury, especially in older adults who may have dehydration, CKD, or other comorbidities. Indomethacin is particularly potent among these options for causing GI toxicity and nephrotoxicity, so it’s the least suitable choice for an older patient when GI bleed risk and AKI are concerns. Acetaminophen does not carry the same GI or kidney risks at usual doses, and tramadol is not an NSAID, so they don’t share this specific risk profile. Naproxen is an NSAID with GI and renal risks as well, but the strongest association with both GI bleed and AKI in this context points to indomethacin.