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Drug Dosing: Geriatric Patients

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...

Pharmacodynamics in Geriatric Patients: Effects of Age

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...

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism

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 Excretion

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...

Antidepressant Drugs: MAOIs and Other Agents

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Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption

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...

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Methylphenidate use in geriatric depression: A systematic review.

Kristin R Smith^1,2, Christie H Kahlon², Jamie N Brown²

¹Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.

International Journal of Geriatric Psychiatry

|April 8, 2021

Summary

Methylphenidate (MPH) may improve geriatric depression symptoms, especially when combined with citalopram for short-term use. Further research is needed to confirm its long-term effectiveness in older adults.

Keywords:

aged antidepressant citalopram depressive disorder elderly late-life depression major depressive disorder methylphenidate psychostimulant treatment-resistant depression

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A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment

A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment

Published on: January 11, 2020

Area of Science:

Geriatric Psychiatry
Pharmacology
Clinical Trials

Background:

Geriatric depression is prevalent and often linked to medical conditions or cognitive issues.
Standard pharmacotherapy for geriatric depression may not be effective for all patients.
There is a need for additional treatment strategies for late-life depression.

Purpose of the Study:

To systematically review the efficacy and safety of methylphenidate (MPH) for treating geriatric depression.
To evaluate MPH as an adjunctive treatment for depression in older adults.

Main Methods:

A systematic review of randomized-controlled and open-label trials was conducted.
Databases searched included PubMed and Embase from 1946/1947 to December 2020.
Inclusion criteria focused on studies of MPH for depression in adults aged 60 years and older.

Main Results:

Five prospective trials met the inclusion criteria.
All studies reported improvements in depressive symptoms with MPH, alone or with citalopram.
Treatment durations varied from 8 to 16 weeks, with MPH doses ranging from 5 to 90 mg/day.

Conclusions:

Methylphenidate (MPH) shows promise as an adjunct treatment for geriatric depression, particularly when combined with citalopram.
Short-term use with gradual dose titration (10-20 mg/day) appears most effective.
Larger, long-term studies are required to fully establish the role of MPH in this population.