Abstract
Aging is a determinant in the biotransformation of drugs with respect to their therapeutic efficacy and safety. Demographics indicate an aging population with a longer life expectancy. The elderly are the most medicated segment of the population, with the average older person taking three times more drugs compared to the young. Most older adults have at least one chronic disease state. Significant aging physiological changes impact on pharmacokinetics and pharmacodynamics, contributing to a higher incidence of adverse events, worsened by polypharmacy. About 10% of all hospital admissions in the elderly relate to drug interactions. Pharmacokinetics refer to the absorption, distribution, metabolism, and excretion of drugs in the body. Pharmacodynamics relate to the pharmacological mechanism of drug action at its particular targets, including therapeutic effects and adverse effects. Pharmacotherapy is a challenge for the health care practitioner because of the need to dose appropriately to account for age-related changes in older adults.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Wauthier V, Verbeeck RK, Calderon PB. The effect of ageing on cytochrome P450 enzymes: consequences for drug biotransformation in the elderly. Curr Med Chem. 2007;14:745–57.
Modig S, Kristensson J, Ekwall AK, et al. Frail elderly patients in primary care—their medication knowledge and beliefs about prescribed medicines. Eur J Clin Pharmacol. 2009;65:151–5.
Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41:67–76.
Handler SM, Hanlon JT, Perera S, et al. Consensus list of signals to detect potential adverse drug reactions in nursing homes. J Am Geriatr Soc. 2008;56:805–15.
DiPiro JT, Spruill WJ, Wade WE, et al. Concepts in clinical pharmacokinetics. 5th ed. Bethesda: American Society of Health-System Pharmacists; 2010.
Rivera R, Antognini J. Perioperative drug therapy in elderly patients. Anesthesiology. 2009;110:1176–81.
Howland R. Effects of aging on pharmacokinetic and pharmacodynamic drug processes. J Psychosoc Nurs Ment Health Serv. 2009;47:15–8.
Delafuente JC. Pharmacokinetic and pharmacodynamic alternation in the geriatric patient. Consult Pharm. 2008;23:324–34.
Sostress C, Gargallo C, Lanas A. Drug-related damage of the ageing gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2009;23:849–60.
Rosenthal T, Nussinovitch N. Managing hypertension in the elderly in light of the changes during aging. Blood Press. 2008;17:186–94.
Delco F, Tchambaz L, Schlienger R, et al. Dose adjustment in patients with liver disease. Drug Saf. 2005;28:529–45.
Carnevale V, Pastore L, Camaioni M, et al. Estimate of renal function in oldest old inpatients by MDRD study equation, Mayo Clinic equation and creatinine clearance. J Nephrol. 2010;23(3):306–13.
Olyaei AJ, Bennett WM. Drug dosing in the elderly patients with chronic kidney disease. Clin Geriatr Med. 2009;25(3):459–527.
Hilmer SN. Clinical pharmacology in the geriatric patient. Fundam Clin Pharmacol. 2007;21:217–30.
Merle M, Laroche ML, Dantoine T, Charmes JP. Predicting and preventing adverse drug reactions in the very old. Drugs Aging. 2005;22:375–92.
Couteur DG. The aging liver. Drug clearance and an oxygen diffusion barrier hypothesis. Clin Pharmacokinet. 1998;34:359–73.
Edholm M. Regulatory aspects of pharmacokinetic profiling in special populations: a European perspective. Clin Pharmacokinet. 2008;47:693–701.
Ali T, Roberts DN, Tiernay WM. Long-term safety concerns with proton pump inhibitors. Am J Med. 2009;122:896–903.
Fock KM, Ang TL, Bee LC, Lee EJ. Proton pump inhibitors: Do differences in pharmacokinetics translate into differences in clinical outcomes? Clinical Pharmacokinet. 2008;47:1–6.
Qasim A, O’Morain CA, O’Connor HJ. Helicobacter pylori eradication: role of individual therapy constituents and therapy duration. Fundam Clin Pharmacol. 2009;23:43–52.
Kamiya T, Adachi H, Hirako M, et al. Impaired gastric motility and its relationship to reflux symptoms in patients with nonerosive gastroesophageal reflux disease. J Gastroenterol. 2009;44:183–9.
Arai K, Takeuchi Y, Watanabe H, et al. Prokinetics influence the pharmacokinetics of rabeprazole. Digestion. 2008;78:67–71.
Pel-Little RE, Schuurmans MJ, Emmelot-Vonk MH, et al. Frailty: defining and measuring of a concept. J Nutr Health Aging. 2009;13(4):390–4.
Patat A, Parks V, Raje S, et al. Safety, tolerability, pharmacokinetics and pharmacodynamics of ascending single and multiple doses of lecozotan in healthy young and elderly subjects. Br J Clin Pharmacol. 2009;67:299–308.
Wynne HA, Blagburn J. Drug treatment in an ageing population: practical implications. Maturitas. 2010;66(3):246–50.
Scholl S, Dellon E, Shaheen N. Treatment of GERD and proton pump inhibitor use in the elderly: practical approaches and frequently asked questions. Am J Gastroenterol. 2011;106:386–92.
Fass R, Johnson D, Orr W, et al. The effect of dexlansoprazole MR on nocturnal heartburn and GERD-related sleep disturbances in patients with symptomatic GERD. Am J Gastroenterol. 2011;106:421–31.
Cho S, Lau S, Tandon V, et al. Geriatric drug evaluation: where are we now and where should we be in the future? Arch Intern Med. 2011;171(10):937–40.
Acknowledgments
The author would like to thank mentors Bhargava Kandala MS, PhD candidate, and Mark Haumschild PharmD, MS, both faculty at the University of Florida College of Pharmacy for providing oversight on the content and clinical relevance of this chapter.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Haumschild, R.J. (2012). Pharmacokinetics of Aging. In: Pitchumoni, C., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1623-5_9
Download citation
DOI: https://doi.org/10.1007/978-1-4419-1623-5_9
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-1622-8
Online ISBN: 978-1-4419-1623-5
eBook Packages: MedicineMedicine (R0)