Drug Res (Stuttg) 2019; 69(S 01): S7-S8
DOI: 10.1055/a-0982-5043
Symposium der Paul-Martini-Stiftung
Georg Thieme Verlag KG Stuttgart · New York

Does Everything Get Slower with Age? Pharmacokinetics in the Elderly

Joachim Höchel
Further Information

Publication History

Publication Date:
15 November 2019 (online)

The pharmacokinetics (PK) of a drug determine its systemic exposure and thereby affect its safety and efficacy. The multitude of physiological changes occurring with aging could impact drug absorption, distribution, metabolism or excretion, the key processes how the body is dealing with drugs. Another important, PK-related topic is the risk for relevant drug-drug interactions considering the number of drugs taken concomitantly by elderly patients. At the same time there are examples for relevant differences in the magnitude of drug effects, i.e. the pharmacodynamics of a drug in an aged vs. young population. These could be caused by differences in the number of receptors in the target organ as well as the response to receptor occupation, or by progressive reduction in homeostatic mechanisms, and could affect the efficacy as well as the safety [1]. Such age-related changes in the pharmacodynamics of a drug shall, however, not be addressed in this article despite their proven clinical relevance.

When discussing age-related changes in the PK of drugs, and in particular their consequences for dosing recommendations in aged patients, one needs to keep in mind that aging is a gradual, complex and progressive process and that there are no established biological age markers. While there is societal consensus to define elderly as individuals aged 65 years or older [1], dividing elderly in three age groups, such as 65 – 75, 76 – 85, and > 85 might help in better describing the aging processes [2].

  • References

  • 1 Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 2003; 38: 843-853
  • 2 Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev 2009; 41: 67-76
  • 3 Nation RL, Vine J, Triggs EJ. et al. Plasma level of chlormethiazole and two metabolites after oral administration to young and aged human subjects. Eur J Clin Pharmacol 1977; 12: 137-145
  • 4 Castleden CM, George CF. The effect of ageing on the hepatic clearance of propranolol. Br J Clin Pharmacol 1979; 7: 49-54
  • 5 Perrie Y, Badhan RKS, Kirby DJ. et al. The impact of ageing on the barriers to drug delivery. J Control Release 2012; 161: 389-398
  • 6 Pea F. Pharmacokinetics and drug metabolism of antibiotics in the elderly. Expert Opin Drug Metab Toxicol 2018; 14: 1087-1100
  • 7 Sotaniemi EA, Arranto AJ, Pelkonen O. et al. Age and cytochrome P450-linked drug metabolism in humans: An analysis of 226 subjects with equal histopathologic conditions. Clin Pharmacol Ther 1997; 61: 331-339
  • 8 Cotreau MM, von Moltke LL, Greenblatt DJ. The influence of age and sex on the clearance of cytochrome P450 3A substrates. Clin Pharmacokinet 2005; 44: 33-60
  • 9 Fliser D, Franek E, Joest M. et al. Renal function in the elderly: impact of hypertension and cardiac function. Kidney Int 1997; 51: 1196-1204
  • 10 Björkman IK, Fastbom J, Schmidt IK. et al. Drug-drug interactions in the elderly. Ann Pharmacother 2002; 36: 1675-1681