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Drug Dosing: Geriatric Patients01:15

Drug Dosing: Geriatric Patients

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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...
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Pharmacodynamics in Geriatric Patients: Effects of Age01:27

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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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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution01:00

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution

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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...
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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption01:22

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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...
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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

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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...
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Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism01:18

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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...
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Trazodone utilization among the elderly in Spain. A population based study.

Diego Macías Saint-Gerons1, Consuelo Huerta Álvarez1, Patricia García Poza1

  • 1Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain.

Revista De Psiquiatria Y Salud Mental
|December 27, 2016
PubMed
Summary

Trazodone use is rising in elderly Spanish patients, often for unapproved conditions like dementia and sleep issues. While doses are low, frequent use with other medications may increase risks.

Keywords:
BIFAPDrug utilisation studyEstudio de utilizaciónTrazodonaTrazodone

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Area of Science:

  • Geriatric Medicine
  • Pharmacology
  • Public Health

Background:

  • Trazodone, approved for depression, has diverse therapeutic applications due to its complex mechanism.
  • Its utilization in the elderly population warrants investigation.

Purpose of the Study:

  • To analyze the trends and patterns of trazodone use among elderly patients in Spain.
  • To identify the primary indications, dosages, and co-medications associated with trazodone prescriptions in this demographic.

Main Methods:

  • A nationwide, longitudinal, and descriptive analysis of trazodone prescriptions in patients over 65 years old.
  • Data sourced from the Spanish Primary Care database (BIFAP) between 2002 and 2011.
  • Calculation of incidence rates and analysis of indications, doses, and concomitant medications.

Main Results:

  • Trazodone incidence increased fivefold from 2002 to 2011, with a rate of 47.2 per 10,000 person-years.
  • Common indications included depression (21.41%), Alzheimer/dementia (20.36%), sleep disorders (16.22%), and anxiety (8.91%).
  • Median dose was 100mg/day, with frequent co-prescription of antihypertensives (53.60%) and CNS depressors (59.32%).

Conclusions:

  • Trazodone use is significantly increasing in the elderly Spanish population.
  • A substantial proportion of trazodone prescriptions are for off-label indications.
  • Concurrent use with interacting medications is common, potentially posing risks to elderly patients.