Drug metabolism and drug interactions in the elderly

doi:10.1053/bega.2001.0249

Best Practice & Research Clinical Gastroenterology

Volume 15, Issue 6, December 2001, Pages 897-918

https://doi.org/10.1053/bega.2001.0249 Get rights and content

Abstract

In the elderly concomitant use of several drugs (polypharmacy) is very common. Thus, the risk for drug interactions might be increased in this population. Since most drugs are hepatically eliminated by various metabolic pathways, liver function has to be considered as an additional factor modifying drug response. This chapter focuses on the hepatic mechanisms of interactions, especially on various inhibitors and inducers of the most important cytochrome P450 isoenzymes involved in drug metabolism. In addition, age-dependent changes in liver function are addressed. Based on pharmacokinetic results with different probe drugs, some inconsistencies in this area are discussed. The most important metabolic drug–drug interactions are independent of the age of the patients. However, since elderly patients consume a greater proportional share of drugs, they represent a population at risk for interactions. Awareness of this clinical problem may help to diminish those risks.

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^f1: All correspondence to: Prof. Dr. Ulrich Klotz. Tel: 0049/711/81 01 – 37 02; Fax: 0049/711/85 92 95; E-mail: [email protected]

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Regular ArticleDrug metabolism and drug interactions in the elderly

Abstract

British Journal of Clinical Pharmacology

Advanced Drug Delivery Reviews

Gastroenterology

Biochemical Pharmacology

Biochemical Pharmacology

Mayo Clinical Proceedings

Journal of the American Pharmacological Association

Clinical pharmacology in an aging population

Clinical Pharmacology and Therapeutics

Including elderly people in clinical trials

British Medical Journal

Polypharmacy in the aged. Practical solutions

Drugs and Aging

Aging: a subject that must be at the top of world agendas

British Medical Journal

Aging research on the international agenda

Journal of the American Medical Association

Effect of age on pharmacokinetics and pharmacodynamics in man

International Journal of Clinical Pharmacology and Therapeutics

Interactions in the elderly

Prescribing for the elderly patient: why do we need to exercise caution?

British Journal of Clinical Pharmacology

Drug dosage in the elderly. Is it rational?

Drugs and Aging

Clinical pharmacokinetic considerations in the elderly

Clinical Pharmacokinetics

Aging and pharmacology

Cancer

Pharmacokinetic and pharmacodynamic changes in the elderly. Clinical implications

Clinical Pharmacokinetics

Drugs and the liver. Part III: Ageing of the liver and the metabolism of drugs

Biopharmaceutics and Drug Disposition

The aging liver. Drug clearance and an oxygen diffusion barrier hypothesis

Clinical Pharmacokinetics

Aging and the liver: an update

Journal of Gerontology: Biological Sciences

Use of in vitro and in vivo data to estimate the likelihood of metabolic pharmacokinetic interactions

Clinical Pharmacokinetics

Phenotyping of drug-metabolizing enzymes in adults: a review of in-vivo cytochrome P450 phenotyping probes

Pharmacogenetics

Human cytochrome P450s: selectivity and measurement in vivo

Xenobiotica

Molecular genetics of the human cytochrome P450 monooxygenase superfamily

Xenobiotica

Interindividual variations in human liver cytochrome P-450 enzymes involved in the oxidation of drugs, carcinogens and toxic chemicals: studies with liver microsomes of 30 Japanese and 30 Caucasians

Journal of Pharmacology and Experimental Therapeutics

Glucuronidation of drugs. A re-evaluation of the pharmacological significance of the conjugates and modulating factors

Clinical Pharmacokinetics

Human UDP-glucuronosyltransferases: metabolism, expression, and disease

Annual Review of Pharmacology and Toxicology

The effects of age and liver disease on the disposition and elimination of diazepam in adult man

Journal of Clinical Investigation

A physiological approach to hepatic drug clearance

Clinical Pharmacology and Therapeutics

The effect of age upon liver volume and apparent liver blood flow in healthy man

Hepatology

Antipyrine as a probe for human oxidative drug metabolism: identification of the cytochrome P450 enzymes catalyzing 4-hydroxyantipyrine, 3-hydroxymethylantipyrine, and norantipyrine formation

Clinical Pharmacology and Therapeutics

Effects of age and gender on in vitro properties of human liver microsomal monooxygenases

Clinical Pharmacology and Therapeutics

Clinical and toxicological consequences of the inductive potential of ethanol

European Journal of Clinical Pharmacology

The effect of age on glucuronidation and sulphation of paracetamol by human liver fractions

British Journal of Clinical Pharmacology

The influence of cigarette smoking and sex on theophylline disposition

American Review of Respiratory Disease

Effect of smoking on caffeine clearance

Clinical Pharmacology and Therapeutics

Influence of endogenous and exogenous effectors on the pharmacokinetics of theophylline. Focus on biotransformation

Clinical Pharmacokinetics

Theophylline pharmacokinetics in normal elderly subjects

Clinical Pharmacology and Therapeutics

Pharmacogenetic phenotyping and genotyping. Present status and future potential

Clinical Pharmacokinetics

Clinical pharmacokinetics of diclofenac. Therapeutic insights and pitfalls

Clinical Pharmacokinetics

Clinical pharmacokinetics and pharmacodynamics of celecoxib: a selective cyclo-oxygenase-2 inhibitor

Clinical Pharmacokinetics

Regular Article
Drug metabolism and drug interactions in the elderly