Drugs and the elderly

Article Abstract:

Rheumatologists and other physicians prescribe drugs for the elderly, who form a high percentage of the patient population, frequently without consideration of the physiologic changes that occur with aging. Dosage guidelines generally suggest that reduced doses be used in the elderly, as the pharmacokinetics and pharmacodynamics of drugs often differ in these patients. These two parameters describe the time factors by which drugs are made available to body tissues through the processes of absorption, distribution, metabolism, and excretion. Pharmacodynamics refers to the blood concentration of a drug and its effects at the target tissues. Although these factors change with aging, few studies have evaluated pharmacodynamics in elderly patients. Physiologic changes that occur during aging affect the functions of many organs, especially the liver and kidneys; these changes lead to the increased accumulation of many, but not all, drugs in the blood. This is likely to have severe consequences if there is a narrow difference between pharmacologically effective and toxic blood levels of a drug. Additionally, previous damage to the kidneys or liver by disorders such as rheumatic diseases can increase the risk of drug toxicity. Benoxaprofen, a non-steroidal anti-inflammatory drug, was introduced in 1980 as an alternative for aspirin treatment in arthritic diseases, but was withdrawn in 1982 after liver and kidney damage were reported and elderly patients died. In general, drugs of this class should be used cautiously in elderly patients. A complicating factor is that elders are not uniform in how their tissues metabolize drugs. Rheumatic diseases and other illnesses may alter drug metabolism. Genetic factors not only influence the incidence of disease, but also affect how drugs are metabolized by body tissues. Research in these areas was presented at a British conference in May 1990, and summarized in the December 1990 issue of Annals of the Rheumatic Diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aging, Drugs, Dosage and administration, Geriatrics, Drug administration and dosage, Adverse drug reactions

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Syncope and presyncope associated with probable adverse drug reactions

Article Abstract:

Fainting (syncope) and extreme dizziness (presyncope) are side effects caused by a variety of drugs as well as by a number of illnesses. Falls and the resulting injuries are a major problem, especially for the elderly, who often take one or more medications. If certain drugs are more likely than others to cause dizziness and fainting, prescriptions can be modified to reduce the risk. This study was undertaken to determine whether certain drugs may lead to fainting or near-fainting, and to identify those patients at greatest risk. Seventy patients with syncope or presyncope were evaluated. Fifteen were taking no drugs at the time, and seven others were not taking any of the drugs suspected of causing fainting. The other 48 patients were taking one or more of the drugs included in the study. These ''culprit'' drugs included antihypertensives, beta-blockers and diuretics (all three commonly used for lowering high blood pressure), antidepressants, and others. There was strong evidence that 12 medications were implicated in fainting spells, particularly the antihypertensives. This is not surprising, because one of the major side effects of high blood pressure medication is low blood pressure upon a change in posture, for example, when getting out of bed. Those patients who were most likely to faint or become dizzy were older and taking more than one medication, including at least one antihypertensive. Nine (13 percent) of the 70 patients were diagnosed with drug-induced syncope or presyncope. Seven of them improved when dosages were decreased, or the drug or drugs were discontinued. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Fainting, Antihypertensive drugs, Antihypertensive agents

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Snipping the thread of life: antimuscarinic side effects of medications in the elderly

Article Abstract:

The antimuscarinic drugs, a large class of drugs including the belladonna alkaloids, have been used both as medicines and as poisons for centuries. These drugs include atropine, antiparkinsonian drugs, antidepressants, muscle relaxants, antipsychotic agents and numerous other drug classes. They are found in many over-the-counter remedies for allergy, diarrhea, colds, nausea, and asthma; they are also used as sedatives. These compounds have been found to induce many unwelcome side effects in some individuals. The elderly in particular are at risk of having unusual or excessive reaction to treatment with antimuscarinic drugs. Side effects often develop over time and they often resemble symptoms frequently found in the elderly, such as dry mouth, constipation, bladder problems, and memory loss, and consequently they are often not properly diagnosed. The situation is further confounded because of the availability of these compounds without prescription. The physician may not be aware of the level of antimuscarinic compounds which the patient may be receiving from nonprescription sources. Elderly patients have been subjected to exploratory surgery as a result of such diagnostic confusion. When antimuscarinic drugs are used with the elderly the strategy of "starting low and going slow" is crucial. Although effective, the use of these drugs by the aged requires constant attention to the possible side effects.

Muscarinic receptors, Muscarinic antagonists, Parasympatholytic agents, Parasympatholytics

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