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Related Concept Videos

Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption01:22

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution01:00

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are not...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
Pharmacodynamics in Geriatric Patients: Effects of Age01:27

Pharmacodynamics in Geriatric Patients: Effects of Age

Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...

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Age-related changes in pharmacokinetics.

Shaojun Shi1, Ulrich Klotz

  • 1Department of Pharmacy of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, People's Republic of China. sjshicn@163.com

Current Drug Metabolism
|April 19, 2011
PubMed
Summary
This summary is machine-generated.

As people age, changes in body composition and organ function affect how drugs are processed and distributed. This pharmacokinetic variability in older adults necessitates a cautious approach to medication, often starting with lower doses.

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Area of Science:

  • Gerontology
  • Pharmacology
  • Clinical Pharmacy

Background:

  • Ageing leads to reduced functional reserve in organs, impacting drug disposition.
  • Elderly individuals often have comorbidities and polypharmacy, complicating drug management.
  • Age-related physiological changes include altered body composition and potentially reduced first-pass metabolism.

Purpose of the Study:

  • To review the pharmacokinetic changes associated with ageing.
  • To highlight the variability in drug disposition among the elderly.
  • To emphasize the importance of age-specific dosing strategies.

Main Methods:

  • Review of age-related changes in drug absorption, distribution, metabolism, and excretion (ADME).
  • Analysis of factors influencing pharmacokinetic variability in older adults, including comorbidity and polypharmacy.
  • Discussion of the impact of ageing on drug clearance and volume of distribution.

Main Results:

  • Body fat increases, while total body water and lean body mass decrease with age, affecting drug distribution.
  • Reduced first-pass metabolism can increase bioavailability for some drugs.
  • Hepatic clearance may decrease for high-extraction drugs, but cytochrome P450 activity is generally preserved.
  • Renal function declines in about two-thirds of elderly individuals, often linked to comorbidities.
  • Significant interindividual variability in drug disposition is prominent in the elderly.

Conclusions:

  • Age-related pharmacokinetic changes, coupled with comorbidity and polypharmacy, create complex drug interactions.
  • The aphorism "start low, go slow" remains a critical principle for prescribing medications to older adults.
  • Further research is needed on the role of drug transporters in age-related pharmacokinetics.