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Dosing Errors: Age-Related Changes in Pharmacokinetics

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Medication Management in Older Adults

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Abstract

Choosing the right medicine and dose regimen for the right patient are critical aspects of achieving quality use of medicines in older people. A comprehensive understanding of pharmacokinetics and pharmacodynamics is central to dose regimen design for older people. Ageing is associated with increased medication use and range of physiological changes that have the potential to effect drug pharmacokinetics and pharmacodynamics in a variety of ways. Understanding the possible impact of age-associated changes in pharmacology can provide a basis of optimising drug therapy in older people where clinical evidence from controlled trials is lacking. It is clear that the interpatient variability in pharmacokinetic and pharmacodynamic processes contributes to the variability in drug response and contributes to the risk of the adverse effects. There is growing evidence to suggest that frailty is an influential factor in contributing to pharmacokinetic and pharmacodynamic variability.

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References

  1. Abernethy DR (1999) Aging effects on drug disposition and effect. Geriatr Nephrol Urol 9:15–19

    Article  PubMed  CAS  Google Scholar 

  2. Hilmer SN, McLachlan A, Le Couteur DG (2007) Clinical pharmacology in geriatric patients. Fundam Clin Pharmacol 21:217–230

    Article  PubMed  CAS  Google Scholar 

  3. McLean AJ, Le Couteur DG (2004) Aging biology and geriatric clinical pharmacology. Pharmacol Rev 56:163–184

    Article  PubMed  CAS  Google Scholar 

  4. Le Couteur DG, Hilmer SN, Glasgow N, Naganathan V, Cumming RG (2004) Prescribing in older people. Aust Fam Physician 33:777–781

    PubMed  Google Scholar 

  5. Turnheim K (2003) When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 38(8):843–853

    Article  PubMed  CAS  Google Scholar 

  6. Cusack BJ (2004) Pharmacokinetics in older persons. Am J Geriatr Pharmacother 2:274–302

    Article  PubMed  CAS  Google Scholar 

  7. Hammerlein A, Derendorf H, Lowenthal DT (1998) Pharmacokinetic and pharmacodynamic changes in the elderly: clinical implications. Clin Pharmacokinet 35:49–64

    Article  PubMed  CAS  Google Scholar 

  8. Nair BR (2002) Evidence based medicine for older people: available, accessible, acceptable, adaptable? Aust J Ageing 21:58–60

    Article  Google Scholar 

  9. Ridda I, Lindley R, MacIntyre RC (2008) The challenges of clinical trials in the exclusion zone: the case of the frail elderly. Australas J Ageing 27:61–66

    Article  PubMed  Google Scholar 

  10. Sitar DS (2007) Aging issues in drug disposition and efficacy. Proc West Pharmacol Soc 50:16–20

    PubMed  CAS  Google Scholar 

  11. Bhutto A, Morley JE (2008) The clinical significance of gastrointestinal changes with aging. Curr Opin Clin Nutr Metab Care 11:651–660

    Article  PubMed  CAS  Google Scholar 

  12. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    Article  PubMed  CAS  Google Scholar 

  13. Russell TL, Berardi RR, Barnett JL, O’Sullivan TL, Wagner JG, Dressman JB (1994) pH-related changes in the absorption of dipyridamole in the elderly. Pharm Res 11:136–143

    Article  PubMed  CAS  Google Scholar 

  14. Stubbs J, Haw C, Dickens G (2008) Dose form modification – a common but potentially hazardous practice. A literature review and study of medication administration to older psychiatric inpatients. Int Psychogeriatr 20:616–627

    PubMed  Google Scholar 

  15. Kotake T, Takada M, Goto T, Komamura K, Kamakura S, Morishita H (2006) Serum amiodarone and desethylamiodarone concentrations following nasogastric versus oral administration. J Clin Pharm Ther 31:237–243

    Article  PubMed  CAS  Google Scholar 

  16. Vestal RE (1997) Aging and pharmacology. Cancer 80:1302–1310

    Article  PubMed  CAS  Google Scholar 

  17. Kyle UG, Genton L, Hans D, Karsegard L, Slosman DO, Pichard C (2001) Age-related differences in fat-free mass, skeletal muscle, body cell mass and fat mass between 18 and 94 years. Eur J Clin Nutr 55(8):663–672

    Article  PubMed  CAS  Google Scholar 

  18. Newman AB, Lee JS, Visser M, Goodpaster BH, Kritchevsky SB, Tylavsky FA, Nevitt M, Harris TB (2005) Weight change and the conservation of lean mass in old age: the Health, Aging and Body Composition Study. Am J Clin Nutr 82:872–878

    PubMed  CAS  Google Scholar 

  19. Hanratty CG, McGlinchey P, Johnston GD et al (2000) Differential pharmacokinetics of digoxin in elderly patients. Drugs Aging 17:353–362

    Article  PubMed  CAS  Google Scholar 

  20. Miura T, Kojima R, Sugiura Y et al (2000) Effect of aging on the incidence of digoxin toxicity. Ann Pharmacother 34:427–432

    Article  PubMed  CAS  Google Scholar 

  21. Salive ME, Cornoni-Huntley J, Phillips CL, Guralnik JM, Cohen HJ, Ostfeld AM, Wallace RB (1992) Serum albumin in older persons: relationship with age and health status. J Clin Epidemiol 45:213–221

    Article  PubMed  CAS  Google Scholar 

  22. Visser M, Kritchevsky SB, Newman AB, Goodpaster BH, Tylavsky FA, Nevitt MC, Harris TB (2005) Lower serum albumin concentration and change in muscle mass: the Health, Aging and Body Composition Study. Am J Clin Nutr 82:531–537

    PubMed  CAS  Google Scholar 

  23. Wynne H (2005) Drug metabolism and ageing. J Br Menopause Soc 11:51–56

    Article  PubMed  Google Scholar 

  24. Sotaniemi EA, Arranto AJ, Pelkonen O, Pasanen M (1997) Age and cytochrome P450-linked drug metabolism in humans: an analysis of 226 subjects with equal histopathologic conditions. Clin Pharmacol Ther 61:331–339

    Article  PubMed  CAS  Google Scholar 

  25. Schwartz JB (2006) Erythromycin breath test results in elderly, very elderly, and frail elderly persons. Clin Pharmacol Ther 79:440–448

    Article  PubMed  CAS  Google Scholar 

  26. Butler JM, Begg EJ (2008) Free drug metabolic clearance in elderly people. Clin Pharmacokinet 47:297–321

    Article  PubMed  CAS  Google Scholar 

  27. Tulner LR, Frankfort SV, Gijsen GJ, van Campen JP, Koks CH, Beijnen JH (2008) Drug-drug interactions in a geriatric outpatient cohort: prevalence and relevance. Drugs Aging 25:343–355

    Article  PubMed  Google Scholar 

  28. Gorski JC, Vannaprasaht S, Hamman MA, Ambrosius WT, Bruce MA, Haehner-Daniels B, Hall SD (2003) The effect of age, sex and rifampicin administration on intestinal and hepatic cytochrome P4503A activity. Clin Pharmacol Ther 74:275–287

    Article  PubMed  CAS  Google Scholar 

  29. Mathew TH, Johnson DW, Jones GRD on behalf of the Australasian Creatinine Consensus Working Group (2007) Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: revised recommendations. Med J Aust 187:459–463

    Google Scholar 

  30. Roberts GW (2006) Dosing of key renally cleared drugs in the elderly-time to be wary of the eGFR. J Pharm Prac Res 3:204–209

    Google Scholar 

  31. Wynne HA, Cope LH, Herd B, Rawlins MD, James OF, Woodhouse KW (1990) The association of age and frailty with paracetamol conjugation in man. Age Ageing 19:419–424

    Article  PubMed  CAS  Google Scholar 

  32. Wynne HA, Yelland C, Cope LH, Boddy A, Woodhouse KW, Bateman DN (1993) The association of age and frailty with the pharmacokinetics and pharmacodynamics of metoclopramide. Age Ageing 22:354–359

    Article  PubMed  CAS  Google Scholar 

  33. Kelly JG, O’Malley K (1992) Nitrates in the elderly. Pharmacological considerations. Drugs Aging 2:14–19

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia

    Andrew J. McLachlan

  2. Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 2139, Australia

    Andrew J. McLachlan

Authors
  1. Andrew J. McLachlan
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  2. Sarah N. Hilmer
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  3. David G. Le Couteur
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Corresponding author

Correspondence to Andrew J. McLachlan .

Editor information

Editors and Affiliations

  1. , Division of Nursing and Midwifery, Latrobe University, Bundoora, 3552, Australia

    Susan Koch

  2. School of Medicine, Victory Springs Senior Health Associates, Johns Hopkins University, Business Center Drive 210, Reisterstown, 21205, USA

    F. Michael Gloth

  3. , Institute of Social Participation, Latrobe University, Bundoora, 3552, Australia

    Rhonda Nay

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McLachlan, A.J., Hilmer, S.N., Le Couteur, D.G. (2010). Dosing Errors: Age-Related Changes in Pharmacokinetics. In: Koch, S., Gloth, F., Nay, R. (eds) Medication Management in Older Adults. Springer, New York, NY. https://doi.org/10.1007/978-1-60327-457-9_12

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  • DOI: https://doi.org/10.1007/978-1-60327-457-9_12

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-60327-456-2

  • Online ISBN: 978-1-60327-457-9

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