The elderly are at higher risk of adverse reactions from non-steroidal anti-inflammatory drugs (NSAIDs), including those due to drug interactions, than younger people. Before prescribing oral NSAIDs in the elderly, the clinician should consider other forms of therapy and topical NSAIDs. When an oral NSAID is used, the dose should be minimised and the need for treatment reviewed periodically to reduce duration of therapy. NSAIDs with a high risk of toxicity (such as phenylbutazone, salicylates, piroxicam and indomethacin) should be avoided in the elderly.