Pharmacodynamic and pharmacokinetic considerations in geriatric psychopharmacology

Age-associated decreases in metabolism and elimination of drugs are sufficient to give one pause before prescribing drugs in the elderly particularly if multiple drugs are to be used. When one factors in concomitant drugs that may inhibit P450-mediated metabolism of other more toxic drugs, genetic deficiency of P450 enzymes, and medical illnesses such as liver and renal failure that will lead to further elevation of drug levels and delay in drug clearance, the likelihood of adverse events when multiple drugs are used in the elderly becomes truly dizzying. In consideration of the pharmacologic principles discussed, when prescribing drugs in the elderly, one might add to the often heard recommendation, "Start low and go slow," a third admonition, "Keep it as simple as possible!"