Geriatric dosing

The elderly are also more likely to suffer from chronic disease and multiple disease states and therefore receive long-term treatment with medications. Considering the high medication utilization of geriatric patients, it is pertinent to focus on geriatric dosing and dosage forms. 

Geriatric Dosing and Dosage Forms Table 3 Medications affected by changes in sensitivity 1909... 

Almkvist, O., Jelic, V., Amberla, K., Hellstrom-Lindahl, E., MeurUng, L., Nordberg, A. (2001) Responder characteristics to a single oral dose of cholinesterase inhibitor a doubleblind placebo-controlled study with tacrine in Alzheimer patients. Dement. Geriatr. Cogn. Disord., 12, 22-32. 

Wilkinson D, Murray], Galantamine, a randomised, double-blind, dose comparison in patients with Alzheimer s disease, Int J Geriatr Psychiatry 16 852-857 2001. 

Initial dose 5 mg, given approximately 30 minutes before breakfast to achieve the greatest reduction in postprandial hyperglycemia. Geriatric patients or those with liver disease may be started on 2.5 mg of the immediate-release formulation. 

Initial dose 5 mg/day, given with breakfast. The recommended dose for geriatric patients is also 5 mg/day. HbA- c level measured at 3-month... 

Adults Initial dosage Moderate symptoms or geriatric or debilitated patients 0.5 to 2 mg given 2 or 3 times/day severe symptoms or chronic or resistant patients 3 to 5 mg 2 or 3 times/day. To achieve prompt control, higher doses may be required. 

Geriatric subjects who received 200 or 400 mg of rimantadine daily experienced considerably more CNS and Gl adverse events than comparable geriatric subjects receiving placebo. CNS events, including dizziness, headache, anxiety, asthenia, and fatigue occurred up to 2 times more often with rimantadine than with placebo. Gl symptoms, particularly nausea, vomiting, and abdominal pain occurred at least twice as frequently with rimantadine than with receiving placebo. The Gl symptoms appeared to be dose-related. 

If you have done some clinical work you may have noticed that digoxin tablets come in two dose sizes - 0.25 mg (usually white), and 0.0625 mg (or 62.5 microgram - often blue in colour). One brand name is Lanoxin PG . Did you know that the PG stands for paediatric-geriatric which recognizes the immature kidneys of the infant and the failing kidneys of the elderly and the need to give smaller doses at both ends of life to avoid digoxin toxicity ... 

Of particular importance in tfie geriatric patient Tachycardia, palpitations, CNSstim-ulation, anxiety, nervousness, dizziness, tremor, cough, hypokalemia (dose-dependent)... 

Of particular importance in the geriatric patient Anticholinergic effects, extrapyramidal symptoms, high doses (greater than 100 mg) may increase risk of sudden death... 

Geriatric Considerations - Summary Diphenoxylate is an analog of meperidine and can cause opiate adverse effects. When discontinued, physical dependence and withdrawal symptoms can occur. Adverse GI effects such as constipation, nausea/vomit-ing, and abdominal pain may result from normal doses. Afropine is added to discourage abuse but can cause anticholinergic adverse effects in the older adult. The benefits of f his drug combination for older adulfs are limifed by fhe risk of adverse effects. 

---