Pharmacodynamic Changes in the Elderly

Fatma İŞLİa, Sevil ÖZGER İLHANb

aTurkish Medicines and Medical Devices Agency, Department of Rational Use of Medicines, Ankara, Türkiye
bGazi University Faculty of Medicine, Department of Medical Pharmacology, Ankara, Türkiye

ABSTRACT
Aging is identified as a progressive loss of functional capacities of most organs, plus a reduction in response to receptor stimulation and homeostatic mechanisms. The importance of age-related changes in drug sensitivity is increasingly understood. The administration of pharmacological agents to older persons often results in a higher incidence of adverse drug reactions compared with the young. This is mainly due to changes in pharmacokinetic and pharmacodynamic properties linked to the aging. While pharmacokinetic changes in the elderly are usually well known and predicted easily, pharmacodynamic changes are understood hardly. Sensitivity to many agents affecting particularly cardiovascular and central nervous system becomes apparent in elderly. Understanding the mechanisms of aging and the biological consequence which they bring about could help answer questions concerning the pharmacodynamic changes observed in the elderly. In addition, this understanding forms the basis of providing of rational drug use in the elderly.
Keywords: Pharmacodynamics; aging

Referanslar

  1. Canio WC. Polypharmacy in Older Adults. Clin Geriatr Med. 2022;38(4):621-5. [Crossref]  [PubMed]
  2. Corsonello A, Pedone C, Incalzi RA. Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions. Curr Med Chem. 2010;17(6):571-84. [Crossref]  [PubMed]
  3. ElDesoky ES. Pharmacokinetic-pharmacodynamic crisis in the elderly. Am J Ther. 2007;14(5):488-98. [Crossref]
  4. Uluoğlu C. Geriatric Psychopharmacology: Drug Responce in Respect to Pharmacokinetic and Pharmacodynamic Considerations. Turkiye Klinikleri J Psychiatry-Special Topics. 2010;3(1):47-59.
  5. Hämmerlein A, Derendorf H, Lowenthal DT. Pharmacokinetic and pharmacodynamic changes in the elderly. Clinical implications. Clin Pharmacokinet. 1998;35(1):49-64. [Crossref]  [PubMed]
  6. Akhtar S. Pharmacological considerations in the elderly. Curr Opin Anaesthesiol. 2018;31(1):11-8. [Crossref]  [PubMed]
  7. Bowie MW, Slattum PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother. 2007;5(3):263-303. [Crossref]  [PubMed]
  8. Burton DG, Allen MC, Bird JL, Faragher RG. Bridging the gap: ageing, pharmacokinetics and pharmacodynamics. J Pharm Pharmacol. 2005;57(6):671-9. [Crossref]  [PubMed]
  9. Thürmann PA. Pharmacodynamics and pharmacokinetics in older adults. Curr Opin Anaesthesiol. 2020;33(1):109-13. [Crossref]  [PubMed]
  10. Roberts J, Tumer N. Pharmacodynamic basis for altered drug action in the elderly. Clin Geriatr Med. 1988;4(1):127-49. [Crossref]  [PubMed]
  11. Coetzee E, Absalom AR. Pharmacokinetic and Pharmacodynamic Changes in the Elderly: Impact on Anesthetics. Anesthesiol Clin. 2023;41(3):549-65. [Crossref]  [PubMed]
  12. Trifirò G, Spina E. Age-related changes in pharmacodynamics: focus on drugs acting on central nervous and cardiovascular systems. Curr Drug Metab. 2011;12(7):611-20. [Crossref]  [PubMed]
  13. Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol. 2003;38(8):843-53. [Crossref]  [PubMed]
  14. Vestal RE, Wood AJ, Shand DG. Reduced beta-adrenoceptor sensitivity in the elderly. Clin Pharmacol Ther. 1979;26(2):181-6. [Crossref]  [PubMed]
  15. Peeters LEJ, Kester MP, Feyz L, Van Den Bemt PMLA, Koch BCP, Van Gelder T, et al Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opin Drug Metab Toxicol. 2019;15(4):287-97. [Crossref]  [PubMed]
  16. Connolly MJ, Crowley JJ, Charan NB, Nielson CP, Vestal RE. Impaired bronchodilator response to albuterol in healthy elderly men and women. Chest. 1995;108(2):401-6. [Crossref]  [PubMed]
  17. Li G, Li K, Li Z, Wang P. Age-dependent changes in beta-adrenoceptor function in human detrusors and possible mechanisms. Chin Med J (Engl). 2003;116(10):1511-4.
  18. Andres TM, McGrane T, McEvoy MD, Allen BFS. Geriatric Pharmacology: An Update. Anesthesiol Clin. 2019;37(3):475-92. [Crossref]  [PubMed]
  19. Tumer N, Scarpace PJ, Lowenthal DT. Geriatric pharmacology: basic and clinical considerations. Annu Rev Pharmacol Toxicol. 1992;32:271-302. [Crossref]  [PubMed]
  20. Guarnieri T, Filburn CR, Zitnik G, Roth GS, Lakatta EG. Contractile and biochemical correlates of beta-adrenergic stimulation of the aged heart. Am J Physiol. 1980;239(4):H501-H8. [Crossref]  [PubMed]
  21. Vuyk J. Pharmacodynamics in the elderly. Best Pract Res Clin Anaesthesiol. 2003;17(2):207-18. [Crossref]  [PubMed]
  22. Turnheim K. Drug dosage in the elderly. Is it rational? Drugs Aging. 1998;13(5):357-79. [Crossref]  [PubMed]
  23. Balaram K, Balachandran S. Psychopharmacology in the Elderly: Why Does Age Matter? Psychiatr Clin North Am. 2022;45(4):735-44. [Crossref]  [PubMed]
  24. Toornvliet R, van Berckel BN, Luurtsema G, Lubberink M, Geldof AA, Bosch TM, et al. Effect of age on functional P-glycoprotein in the blood-brain barrier measured by use of (R)-[(11)C]verapamil and positron emission tomography. Clin Pharmacol Ther. 2006;79(6):540-8. [Crossref]  [PubMed]
  25. Lippa AS, Pelham RW, Beer B, Critchett DJ, Dean RL, Bartus RT. Brain cholinergic dysfunction and memory in aged rats. Neurobiol Aging. 1980;1(1):13-9. [Crossref]  [PubMed]
  26. Morley JE, Flood JF, Silver AJ. Opioid peptides and aging. Ann N Y Acad Sci. 1990;579:123-32. [Crossref]  [PubMed]
  27. Roth GS. Mechanisms of altered hormone-neurotransmitter action during aging: from receptors to calcium mobilization. Annu Rev Gerontol Geriatr. 1990;10:132-46. [Crossref]