Formulations elderly

The incidence of diabetes and decreased glucose tolerance among the elderly is well documented [116,135-137]. Because of this, formulators should make every attempt to avoid using any sugar-containing excipients in their production processes. 

Solid oral dosage forms, particularly tablets, are the preferred type of formulation in the United States. Not only are these products widely accepted by consumers, but they are also relatively cheaper to develop and manufacture than oral liquids or suspensions, par-enterals, or suppositories. Figure 4 shows, quite clearly, that even the elderly primarily make use of solid oral dosage forms [162]. 

Chewable Tablets. It has already been noted that most elderly patients experience a decrease in their ability to chew efficiently [125,137,138,143]. Therefore, by virtue of their design, chewable tablets are not often recommended for use by elderly patients (particularly those who are edentulous) 155-163,164], Most chewable formulations also rely on an adequate amount of chewing action to obtain full release of their ingredients (e.g., chewing promotes the foaming action provided by some chewable antacid products). So, aside from being difficult form the elderly patient to use, full benefit of a chewable dosage form may not be achieved by these patients. Additionally, the use of chewable tablets by denture wearers may cause local irritation in the oral cavity [155]. 

Liquids and Suspensions. Most liquid formulations are not packaged in unit-dosage form. Therefore, before administration, the proper amount of medication to be taken for each dose must be measured. This additional requirement may compound any difficulties a patient may have in following a prescribed schedule. Patients suffering from visual impairment, arthritis, or tremors associated with neurological disorders are particularly likely to become frustrated with this type of formulation. Visual impairments make it difficult, if not impossible, for many elderly patients to measure the prescribed amounts of medication accurately. Impaired dexterity, owing to tremors or arthritis, may have effects on a patient s ability to hold both a spoon and a bottle at the same time while pouring out the desired amount of liquid. 

Effervescent Tablets. Effervescent tablets are another means of supplying medications to the elderly. This type of formulation provides the patient with an easy-to-swallow product that is aesthetically pleasing (i.e., forms a clear solution, rather than a cloudy... 

Professor Meyer was born at Dorpat, Estonia, on September 29, 1883, the elder son of Hans Horst Meyer—who held the chair of experimental pharmacology at the University of Vienna and formulated the modern theory of narcosis known as the Overton-Meyer theory. Two years later, his father became professor at Marburg/Lahn, and it was in this city that Kurt H. Meyer had his early education. The scholarly atmosphere in which he matured, where chemistry and medicine were always very much in the foreground, was to influence him throughout his lifetime. From his father, he inherited his desire for scientific study and research, and from his mother, his taste for the fine arts. His younger brother became a famous heart-surgeon. 

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. ... 

Combinations of active ingredients, specific pharmaceutical formulations, specific use, and company names can be included in the product name. Examples of this are shown in Table 8.2. This combinations and mixes of names can be very complicated and disturbing for the health-care and for the patients, especially for the elderly. It not easy to know what is important. Is ZOC a company or a pharmaceutical formulation changing the dosing schedule Patient safety in the reconciliation of medicines as described in Chapter 10 is very important and must not be neglected. 

Perkins AC, Wilson CG, Blackshaw PE, Vincent RM, Danserau RJ, Juhlin KD, Bekker PJ, Spiller RC. Impaired oesophageal transit of capsule versus tablet formulations in the elderly. Gut 1994 35 1363-1367. 

Elderly In an expanded access program using a buffered formulation of didanosine for the treatment of advanced HIV infection, patients 65 years of age and older had a higher frequency of pancreatitis (10%) than younger patients (5%). 

Morphine 3 12-20 Basehne drug. The dose is adjusted when changing from parenteral formulation to oral, with a 3-fold increase due to low bioavaUabUity. The amount needed shows large variations between individuals. Particular sensitivity in the elderly and in patients with kidney disease. Risk of abuse... 

A-Nitrosodiethanolamine at levels of 600-7386 ppb was detected in 11 samples of cosmetics in the United States which included hand creams, face creams, shampoos, cocoa butter cream, moisturizing lotion and a make-up remover (all products listed diethanolamine and/or triethanolamine as ingredients) (Tunick etal., 1982). TV-Nitroso-diethanolamine was found in all seven cosmetic formulations one with traces (< 10 ng/g) and six at levels of 41 7 000 ng/g and in 12 of 13 lotions (seven with traces <10 ng/g and five with 14-140 ng/g) and in eight of nine hair shampoos (three with traces < 10 ng/g and live with 17-280 ng/g) in the United States (Fan et al., 1977b). Of 191 cosmetics analysed, 77 contained from 10 to more than 2000 ppb N-nitrosodiethanolamine (Elder, 1980). Westin etal. (1990) analysed 20 different suntan lotions in Israel and found that three were contaminated with 17-27 ppb TV-nitroso-diethanolamine (with traces 5-10 ppb). 

Sodium phosphate is available as a nonprescription liquid formulation and by prescription as a tablet formulation. When taking these agents, it is very important that patients maintain adequate hydration by taking increased oral liquids to compensate for fecal fluid loss. Sodium phosphate frequently causes hyperphosphatemia, hypocalcemia, hypernatremia, and hypokalemia. Although these electrolyte abnormalities are clinically insignificant in most patients, they may lead to cardiac arrhythmias or acute renal failure due to tubular deposition of calcium phosphate (nephrocalcinosis). Sodium phosphate preparations should not be used in patients who are frail or elderly, have renal insufficiency, have significant cardiac disease, or are unable to maintain adequate hydration during bowel preparation. 

The parenteral formulation diethylstilbestrol diphosphate is less commonly used than the oral formulation. In Japan, 24 elderly patients with advanced relapsed prostatic cancer were treated with high doses supplemented with ethi-nylestradiol (doses unclear) there was some slight therapeutic effect, but there were gastrointestinal symptoms and fluid retention (48). Also in Japan, a few patients with advanced disease were treated using intravenous diethylstilbestrol diphosphate 500 mg/day for 20 consecutive days to a total dose of 10 g the authors conclusion was more positive but adverse events were not specified (49). 

A once-daily modified-release formulation of gliclazide has been reviewed (157). It has a low tendency to cause hypoglycemia in all patients, including the elderly and patients with mild renal insufficiency. Arthralgia, arthritis, back pain, and bronchitis are its most commonly reported adverse effects, although it is not clear whether they are all related to gliclazide. 

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