Pharmacokinetics older people

The decision to use these agents should be made with considerable caution, and only after possible underlying causes of the patient s symptoms have been explored and treated appropriately. Although surveys indicate that BZDs are frequently prescribed for elderly patients, the NIH Consensus Development Conference stated that the efficacy and safety of sedatives and hypnotics have not been established for older people, nor has the extent to which they contribute to or alleviate sleep problems (302, 305, 306). Saizman (307) has pointed out that relatively few research studies, most of which are seriously flawed, have examined the therapeutic effect of these agents in elderly patients. Thus, recommendations for the use of BZDs in elderly patients are derived almost exclusively from studies of young adult patients, studies of pharmacokinetics and toxicity in elderly patients, and clinical and anecdotal experience. 

Consider the difference in response to drugs between older and younger people. Treatment should reflect biological age (rather than chronological). Pharmacokinetics, pharmacodynamics, tolerability, adverse reactions, economy and patient choice will all influence therapy chosen. Most commonly, car-bamazepine or sodium valproate are chosen for older people as their effects in older people are well documented. Both show a favourable balance of safety, efficacy and economy. Phenytoin is less preferable because of drug interactions, adverse effects and potential for toxicity (zero order kinetics). 

O Connor-SemmesRL, Kersey K, WiUiamsDH, Lam R, Koch KM Effect of ranitidine on tile pharmacokinetics of triazolam and a-hydrcc triazolam in both young (19-60 years) and older (61-78 years) people. CUnPharmacol 7h r(2001) 70,126-31. 

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