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Paracetamol in Older People: Towards Evidence-Based Dosing?
Paola Mian1, Karel Allegaert2,3,4, Isabel Spriet5,6
1Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Room NA-1723, Wytemaweg 80, Rotterdam, 3015 CN, The Netherlands. p.mian@erasmusmc.nl.
Drugs & Aging
|June 20, 2018
Summary
Physiological changes in older adults affect paracetamol pharmacokinetics, with decreased volume of distribution and clearance observed. More research is needed to establish evidence-based dosing for this population.
Area of Science:
- Gerontology
- Pharmacology
- Clinical Pharmacy
Background:
- Paracetamol is a common analgesic for older adults, often prescribed using empirical guidelines.
- Age-related physiological changes can alter paracetamol pharmacokinetics and efficacy.
- Current dosing strategies may not fully account for altered drug metabolism in the elderly.
Purpose of the Study:
- To review existing literature on paracetamol pharmacokinetics and safety in individuals aged over 60.
- To identify knowledge gaps for developing evidence-based paracetamol dosing regimens in older populations.
- To adapt concepts from pediatric dosing guidelines for geriatric paracetamol use.
Main Methods:
- Systematic literature search for studies on paracetamol pharmacokinetics and safety in older adults (≥60 years).
- Inclusion of studies with specific analyses of pharmacokinetic or safety data in older subjects.
- Screening of 6088 articles, with 27 studies meeting the inclusion criteria (20 pharmacokinetic, 7 safety).
Main Results:
- No significant changes in paracetamol absorption were noted with aging.
- A decreased volume of distribution (Vd) was observed in robust (3.9-22.9%) and frail (20.3%) older adults compared to younger individuals.
- Paracetamol clearance was reduced in older adults (29-45.7%) and further reduced in frail individuals (37.5%) compared to younger subjects.
Conclusions:
- Limited and heterogeneous evidence hinders definitive conclusions on paracetamol safety risks in older adults.
- Further research is required to address safety at therapeutic doses and altered pharmacokinetics in frail elderly individuals.
- Determining appropriate dosage adjustments based on pharmacokinetic changes in both robust and frail older adults remains an open question.
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