Elderly/geriatrics

Elderly Geriatric patients often require reduced dosage because of impaired renal function. In patients with severe impairment, dosage should not exceed 20 g in 48 hours. Monitor serum magnesium in such patients. 

Elderly- Geriatric patients are particularly sensitive to the side effects of... 

Stillman MJ, Stillman MT. Appropriate use of NSAIDs considering cardiovascular risk in the elderly. Geriatrics 2007 62 16-21. Stillman MJ, Stillman MT. Choosing nonselective NSAIDs and selective COX-2 inhibitors in the elderly. A clinical use pathway. 

Bennett WM. Drug-related renal dysfunction in the elderly. Geriatr Nephrol Urol 1999 9 21-25. 

Lantz, M., E. Buchalter, and V. Giambanco. 1999. St. John s wort and antidepressant drug interactions in the elderly. /. Geriatr. Psychiatr. Neurol. 12(1) 7-10. 

Aniracetam (6), launched in 1993 in both Japan and Italy for the treatment of cognition disorders, is in Phase II trials in the United States as of this writing. In clinical studies it has been shown to cause some improvement in elderly patients with mild to moderate mental deterioration (63), and in geriatric patients with cerebral insufficiency (64). In a multicenter double-blind placebo-controUed trial involving 109 patients with probable AD, positive effects were observed in 36% of patients after six months of treatment (65), a result repeated in a separate study of 115 patients (66). A review of the biological and pharmacokinetic properties, and clinical results of aniracetam treatment in cognitively impaired individuals is available (49). 

Geriatric factors a variety of factors, both pharmacokinetic and pharmacodynamic, that contribute to variable dmg responses in the elderly. These responses are not seen for every class of dmg. Thus, the depressant effects of the glycosides also appear to increase with aging (116,117). 

Petrovic M, Vandierendonck A, Mariman A, et al Personality traits and socioepi-demiological status of hospitalised elderly benzodiazepine users. Int J Geriatr Psychiatry 17 733-738, 2002... 

Nomura, K., Murai, H., Nakahashi, T., Mashiba, S., Watoh, Y., Takahashi, T., and Morimoto, S. (2008). Qutbreak of norovirus gastroenteritis in elderly evacuees after the 2007 Noto Peninsula earthquake in Japan. /. Am. Geriatr. Soc. 56, 361-363. 

J. Roberts and N. Turner, Pharmacodynamic basis for altered drug action in the elderly, Clin. Geriatr. Med., 4, 127 (1988). 

R. B. Wallace, Drug utilization in the rural elderly Perspectives from a population study, in Geriatric Drug Use—Clinical and Social Perspectives (S. R. Moore and R. W. Teal, eds.), Permagon Press, New York, 1985, pp. 78-85. 

J. E. Finchman, Over-the-counter drug use and misuse by the ambulatory elderly A review of the literature, J. Geriatr. Drug Ther., 1, 3 (1986). 

Olde Rikkert, M. G. Rigaud, A. S. (2001). Melatonin in elderly patients with insomnia. A systematic review. Z. Gerontol. Geriatr. 34, 491-7. 

Dufour MC, Archer L and Gordis E (1992). Alcohol and the elderly. Clinics in Geriatric Medicine, 8, 127-141. 

Forsell Y and Fastbom J (2000). Psychotropic drug use in relation to psychiatric syndromes in a very elderly population. International Journal of Geriatric Psychopharmacology, 2, 86-89. 

Finally, drug absorption and excretion have not been evaluated in pediatric or geriatric populations. However, here again the tolerability of rifaximin in childhood and in the elderly has found to be extremely good [33]. 

From Cusack BJ. Pharmacokinetics in older persons. Am J Geriatr Pharm 2004 2 274-302 and Chapron DJ. Drug disposition and response. In Delafuente JQ Stewart RB, eds. Therapeutics in the Elderly 3rd ed. Cincinnati, OH Harvey Whitney, 2000 257-288. 

Data from KotylarM, Gray SL, Lindblad Cl, Hanlon JT. Psychiatric Manifestations of Medications in the Elderly. In Malletta C, Agronin M (editors). Principles and Practice of Geriatric Psychiatry, 1st ed. Philadelphia, PA Lippincott Williams and Wilkins 2005,605-615. 

Drug-related problems in the elderly is intended to serve as a source of information and clinical support in geriatric pharmacotherapy for students as well as all health care professionals, e.g. physicians, nurses and pharmacists. Pharmacotherapy is of great importance to all mankind. Drugs are however powerful and must be handled appropriately. This is especially important for elderly patients. 

Hanlon JT, Lindblad Cl, Hajjar ER et al. (2003) Update on drug-related problems in the elderly. Am J Geriatr Pharmacother 1(1) 38-43... 

Horne R and Weinman J (1999) Patients beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47(6) 555-567 Kannisto V, Lauritsen J, Thatcher AR et al. (1994) Reductions in mortality at advanced age several decades of evidence from 27 countries. Population and development review 20(4) 793-810 Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients a meta- analysis of prospective studies. JAMA 279(15) 1200-1205 LeSage J (1991) Polypharmacy in geriatric patients. Nurs Clin North Am 26(2) 273-290 Pitkala KH, Strandberg TE, Tilvis RS (2001) Is it possible to reduce polypharmacy in the elderly ... 

The efficacy document E7 (ICH 1993) states that the drug should be studied in all patient groups, elderly included, for which they have a significant utility. It also includes new uses, new formulations and new combinations of established medicinal products when there is specific reason to expect that conditions common in the elderly (e.g. renal or hepatic impairment, impaired cardiac function, concomitant illness or medication) are likely to be encountered. This also applies for when the geriatric patients response (safety, tolerability, efficacy) is different from the nongeriatrics. ... 

Bogunovic Ol and Greenfield SF (2004) Practical geriatrics Use of benzodiazepines among elderly patients. Psychiatr Serv 55(3) 233-235... 

Flaherty 1H (1998) Psychotherapeutic agents in older adults. Commonly prescribed and over- the-counter remedies causes of confusion. Clin Geriatr Med 14(1) 101-127 Gallagher P, Barry P, O Mahony D (2007) Inappropriate prescribing in the elderly. 1 Clin Pharm Ther32(2) 113-121... 

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