Alterations in drug disposition in older adults: a focus on geriatric syndromes

Dorsa Maher, Nagham Ailabouni, Arduino Mangoni, Michael Wiese, Emily Reeve

    Research output: Contribution to journalReview articlepeer-review

    Abstract

    Introduction
    Age-associated physiological changes can alter the disposition of drugs, however, pathophysiological changes associated with geriatric syndromes in older adults may lead to even greater heterogeneity in pharmacokinetics. Geriatric syndromes are common health problems in older adults which have multifactorial causes and do not fit into distinct organ-based disease categories. With older adults being the greatest users of medications, understanding both age- and geriatric syndrome-related changes is important clinically to ensure safe and effective medication use.
    Areas covered
    This review provides an overview of current evidence regarding pharmacokinetic alterations that occur with aging and in common geriatric syndromes, including frailty, sarcopenia, dementia, polypharmacy and enteral feeding. The evidence is presented according to the four primary pharmacokinetic processes (Absorption, Distribution, Metabolism and Excretion).
    Expert opinion
    There is some evidence to inform our understanding of the impact of chronological aging and various geriatric syndromes on drug disposition. However, many areas require more research, including drug induced inhibition and induction of cytochrome P450 enzymes and the clinical utility of emerging methods for estimating renal function. There is a need to develop tools to predict alterations in drug disposition in subgroups of older adults, particularly where the currently available clinical information is sparse.
    Original languageEnglish
    Number of pages12
    JournalExpert Opinion on Drug Metabolism and Toxicology
    DOIs
    Publication statusE-pub ahead of print - 2 Nov 2020

    Keywords

    • Advancing age
    • Aging
    • Dementia
    • Drug disposition
    • Enteral feeding
    • Frailty
    • Geriatric syndromes
    • Pharmacokinetics
    • Polypharmacy
    • Sarcopenia

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