Pharmacokinetic dosage guidelines for elderly subjects

Turnheim, Klaus

doi:10.1517/17425255.1.1.33

Cited by 20 publications

(12 citation statements)

References 163 publications

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“…DRPs arise because of the increasing number of medications required by this age group, fragmented systems of care, pre-existing health conditions, and the pharmacokinetic and pharmacodynamic changes that occur with aging (Bigos, Bies, & Pollock, 2006;Cusack, 2004;Gurwitz, 2004;Hajjar et al, 2003;Turnheim, 2004Turnheim, , 2005. Avoiding use of high-risk drugs is an important strategy in reducing DRPs.…”

Section: Introductionmentioning

confidence: 99%

Health outcomes associated with potentially inappropriate medication use in older adults

Fick

Mion

Beers

et al. 2007

Research in Nursing & Health

256

198

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The purpose of this study was to examine the prevalence of potentially inappropriate medication use (PIMs) among community-dwelling older adults and the association between PIMs and health care outcomes. Participants were 17,971 individuals age 65 years and older. PIM use was defined by the Beers criteria. Drug-related problems (DRPs) were defined using ICD-9 codes. Forty percent of the 17,971 individuals filled at least 1 PIM prescription, and 13% filled 2 or more PIM prescriptions. Overall DRP prevalence among those with at least 1 PIM prescription was 14.3% compared to 4.7% in the non-PIM group (p < .001). In conclusion, preventing PIM use may be important for decreasing medication-related problems, which are increasingly being recognized as requiring an integrated interdisciplinary approach. Keywordsmedications; healthcare costs; geriatrics; adverse drug events Drug-related problems (DRPs) are prevalent in the older adult population and pose a major patient safety concern. DRPs arise because of the increasing number of medications required by this age group, fragmented systems of care, pre-existing health conditions, and the pharmacokinetic and pharmacodynamic changes that occur with aging (Bigos, Bies, & Pollock, 2006;Cusack, 2004;Gurwitz, 2004;Hajjar et al., 2003;Turnheim, 2004Turnheim, , 2005. Avoiding use of high-risk drugs is an important strategy in reducing DRPs. The purpose of this study was to examine both the prevalence of potentially inappropriate medication (PIMs) use among community-dwelling older adults and the association between PIMs and health care outcomes.One method promoted to identify high-risk medications is the use of an explicit list of PIMs. PIMs were first devised and publicized by Beers et al. for nursing home residents and subsequently expanded to include older adults in all settings (Beers, 1997). PIMs are medications identified through expert panel review as having risks that outweigh benefits (Beers et al., 1991). Since the early 1990s, the prevalence of PIMs has been examined in a (Lau, Kasper, Potter, & Lyles, 2004), outpatient (Aparasu & Sitzman, 1999Curtis et al., 2004), acute care (Onder et al., 2005), and community settings (Zhan et al., 2001). For research purposes, use of explicit criteria is generally preferred over the use of implicit criteria applied by expert reviewers.The clinical validity of using a list of medications based on expert panel review and explicit criteria has been questioned as being overly simplistic and not including all the common drugs causing problems in older adults (Crownover & Unwin, 2005;Shorr, 2004). Moreover, despite the numerous reports of the prevalence of PIMs, only a few investigators (Fu, Liu, & Christensen, 2004;Thapa, Gideon, Cost, Milam, & Ray, 1998) have examined whether PIMs are associated with adverse clinical outcomes. Therefore, we investigated the outcomes associated with PIM use in a population of community-dwelling older adults.The Beers criteria have been revised recently; hence, the current prevalence of PIMs in...

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Section: Introductionmentioning

confidence: 99%

Health outcomes associated with potentially inappropriate medication use in older adults

Fick

Mion

Beers

et al. 2007

Research in Nursing & Health

256

198

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“…This change is expected to affect phase I catalysis by cytochrome P450 enzymes more than phase II conjugation (2,10,11). As a consequence, both total drug clearance (Cl) and free drug Cl can decrease ( Table 1).…”

Section: Age-related Changes In Organ Functionmentioning

confidence: 99%

“…For practical reasons, an age Ͼ65 years is used to describe elderly people (2). In general, purely age-related effects should be distinguished from those of coexisting diseases (3).…”

mentioning

confidence: 99%

Review on Pharmacokinetics and Pharmacodynamics and the Aging Kidney

Aymanns¹,

Keller²,

Maus³

et al. 2010

Clinical Journal of the American Society of Nephrology

130

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In people who are aged >65 years, pharmacokinetics are influenced more by the loss of kidney function than by the aging process of any other organ. A GFR of 30 to 60 ml/min, suggestive of stage 3 kidney disease, is observed in 15 to 30% of elderly people. Drug dosing must be adjusted to both changing pharmacokinetics and pharmacodynamics; the pharmacodynamics might be influenced by the aging of other organs, too. Using our NEPharm database, we extracted abstracts with pharmacokinetic parameters since 1999 from a weekly PubMed search. The recorded data were analyzed and compared with published recommendations on drug dosage and use in the elderly. Purely age-related changes in pharmacokinetic parameters were recorded from publications on 127 drugs. The analysis of our NEPharm records revealed an average (mean ؎ SD) age-related prolongation of half-life of 1.39-fold (corresponding to ؉39 ؎ 61%). Contrasting to common opinion, mean changes in clearance (؊1 ؎ 54%) and volume of distribution (؉24 ؎ 56%) were even less. The modest changes in pharmacokinetics do not suggest general dosage modifications in the elderly for most drugs. Changes in pharmacodynamics justify the common medication rule in the elderly-"start low ؉ go slow"-especially for drugs that act on the central nervous system; however, in the case of anti-infective and anticancer therapy, the rule should be "hit hard ‫؍‬ start high ؉ go fast" to produce the target effect also in the elderly.

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“…Organic dyspepsia may be more common than functional dyspepsia in the elderly 2 . The elderly have a slower metabolism of drugs by the kidney 3 …”

Section: Introductionmentioning

confidence: 99%

Review article: building an algorithm for the management of geriatric acid‐related disorders in Asia

Chan

Kinoshita

2007

Ali Pharm Thera Symp Ser

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Summary The special needs of the elderly must be considered in the treatment of acid‐related disorders in older patients. Workshop participants discussed the Genval workshop report algorithm as a step toward building a consensus on the management of elderly patients in Asia. The consensus reached is summarized as follows: (i) old age alone is an indication for endoscopic investigation of reflux symptoms; (ii) elderly patients should undergo endoscopy when they present with acid reflux symptoms; (iii) a biopsy‐based test for Helicobacter pylori should be performed if endoscopy is done, and eradication of H. pylori is warranted as it will reduce the risk of peptic ulcers and may retard the progression of early precancerous gastric lesions; (iv) it is not recommended to routinely take additional biopsies for histology in patients with H. pylori infection in the absence of any macroscopic suspicious lesions; (v) patients with reflux disease LA grade B or below should be started on a standard‐dose proton pump inhibitor for 4–8 weeks, and then followed by step‐down to on‐demand therapy; (vi) patients with LA grade C or above reflux oesophagitis should be initially given standard‐dose proton pump inhibitor therapy for at least 8 weeks and then continue with maintenance proton pump inhibitor therapy.

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Pharmacokinetic dosage guidelines for elderly subjects

Cited by 20 publications

References 163 publications

Health outcomes associated with potentially inappropriate medication use in older adults

Health outcomes associated with potentially inappropriate medication use in older adults

Review on Pharmacokinetics and Pharmacodynamics and the Aging Kidney

Review article: building an algorithm for the management of geriatric acid‐related disorders in Asia

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