Phenytoin Dosage in the Elderly

Lambie, Diana; Caird, F. I.

doi:10.1093/ageing/6.3.133

Cited by 15 publications

(4 citation statements)

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“…The maximum rate of metabolism (V max ) declined gradually with age, and significantly lower values were seen in the elderly group compared with younger adults [17]. Other smaller studies have also shown that phenytoin metabolism is reduced in the elderly [17][18][19][20][21][22]. The smaller V max means that phenytoin metabolism becomes saturated at lower concentrations than in younger patients.…”

Section: Phenytoinmentioning

confidence: 99%

Epilepsy in the elderly

Leppik

2001

Curr Neurol Neurosci Rep

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The active prevalence rate of epilepsy among persons over 65 years of age is approximately 1.5%, about twice the rate in younger adults. Treatment of epilepsy in the elderly is complicated by alterations in drug metabolism, use of concomitant medications, and multiple medical problems. Drug interactions are a major issue, and a full knowledge of the isoenzyme profile and protein-binding characteristics of each drug (antiepileptic and other) must be known.

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Section: Phenytoinmentioning

confidence: 99%

Epilepsy in the elderly

Leppik

2001

Curr Neurol Neurosci Rep

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“…The maximum rate of metabolism (V max ) declined with age, and significantly lower values were seen in the elderly group compared with younger adults. 24 Other smaller studies have also shown that phenytoin metabolism is reduced in the elderly, [25][26][27][28][29] indicating that metabolism may become saturated at lower concentrations than in younger patients. Smaller maintenance doses of phenytoin are needed to attain desired unbound serum concentrations, and relatively small changes in dose (Ն10%) are recommended when making dosing adjustments.…”

Section: Phenytoinmentioning

confidence: 99%

Epilepsy in the Elderly

Leppik

2002

Semin Neurol

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The elderly are the most rapidly growing segment of our population, and onset of epilepsy is higher in this age group than in any other. With advancing age, there are changes in drug absorption, disposition, and binding. In addition, within the elderly are subgroups: (1) elderly healthy except for epilepsy (EH) and (2) elderly with multiple medical problems (EMMP). This review examines the factors that need to be considered when selecting the appropriate antiepileptic drug (AED) for an elderly person with epilepsy. Both the older and newer AEDs are reviewed.

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“…In addition to changes in protein binding, PHT metabolism is reduced in the elderly (20,37-39). The decreased V,, associated with aging causes saturation of enzyme sites at lower total concentrations than occurs in younger adults (28, 40,41). Hence, careful changes in dose, relying on 30-mg capsules as well as 100-mg capsules, are important.…”

Section: Phtmentioning

confidence: 99%

The Effect of Age on Pharmacokinetics of Antiepileptic Drugs

Lj¹

1995

Epilepsia

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Management of epilepsy in the elderly requires understanding of the unique biochemical and pharmacologic characteristics of this patient population. Accurate assessment of seizures and identification of epilepsy syndromes, thorough neurologic assessment to define etiology, and comprehensive evaluation of the patient's health and living situation are necessary for informed management decisions. Challenges to treatment include concomitant diseases, polypharmacy with accompanying drug interactions, and changes in physiology, such as changes in renal clearance and hepatic function than alter drug absorption, protein binding, metabolism, and elimination. Elderly patients with declining intellectual function, motor impairment, or altered sensory function may be especially susceptible to dose-related CNS side effects of antiepileptic drugs (AEDs). Drugs prescribed for concomitant illnesses such as hypertension, cardiovascular disease, infections, behavioral problems, and gastrointestinal disturbances may alter absorption, distribution, and metabolism of AEDs, with an adverse impact on efficacy and increased occurrence of adverse effects. The AEDs may induce metabolism of other drugs, resulting in decline in target response. Addition of an AED to an elderly patient's medical regimen requires careful review of all prescribed drugs. Optimal care of elderly patients with epilepsy includes use of free drug levels to monitor AED concentrations, careful dose selection, and sensitivity to the social problems that may occur in this population.

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Phenytoin Dosage in the Elderly

Cited by 15 publications

References 0 publications

Epilepsy in the elderly

Epilepsy in the elderly

Epilepsy in the Elderly

The Effect of Age on Pharmacokinetics of Antiepileptic Drugs

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