OBJECTIVE: To identify medication use patterns among elderly people residing in areas with different socioeconomic status in the city of Fortaleza, Brazil. METHODS: A total of 668 elderly (aged 60 years or older) residing in the city of Fortaleza, Ceará, Brazil, selected from a multistage random sampling stratified by socioeconomic status (higher, intermediate, and lower areas), were interviewed in a household survey. Descriptive statistics for dichotomous variables were presented as percent of the respective totals, and those for continuous variables as mean +/- SD. Multivariate analyses were performed to identify factors associated with the use of prescription, non-prescription and inappropriate) drugs. RESULTS: Most (80.3% in the higher area) were on at least one non-prescription drug. More than one third (37.4%) were on at least one non- prescription drug and nearly 20% used at least one inappropriate in the lower area. PD use was associated with advanced age (OR=1.7, 95% CI=1.1-2.8); male sex (OR=0.5, 95% CI=0.3-0.7); health service visits (OR=2.5, 95% CI=1.9-3.1); chronic diseases (OR=4.0, 95% CI=2.5-6.2); and higher socioeconomic status (OR=2.0, 95% CI=1.5-2.6).Non- prescription drug use was associated with disability (OR=1.5, 95% CI=1.1-2.2), and higher socioeconomic status (OR=0.6; 95% CI=0.5-0.8). Inappropriate drugs use was mainly associated with male sex (OR=0.4, 95% CI=0.2-0.8); chronic diseases (OR=2.0, 95% CI=1.2-3.3); and higher socioeconomic status (OR=0.7, 95% CI=0.5-0.9). CONCLUSIONS: The proportions of elderly using prescription, non-prescription and inappropriate drugs were remarkable and inequalities were seen particularly among those from different socioeconomic status. These results emphasize the need for strategies to optimize the access and rationalize the use of drugs for elderly people in Brazil.