Adverse Drug Reactions in the Elderly

Abstract

Changes in pharmacokinetics and pharmacodynamics, common polymorbidity and polypharmacy as well as changes in medication adherence represent the most important reasons for increased risk of adverse drug reactions (ADRs) in elderly patients. The use of certain drugs in elderly patients is associated with increased probability of ADRs in comparison with the administration of the same medications in younger patients. This finding was the reason for creation of lists of potentially inappropriate medications in elderly patients. The Beers criteria represent the most commonly used list of potentially inappropriate medications in elderly patients.1 Drugs with anticholinergic activity are included in such lists. They may frequently cause ADRs such as dry mouth, urinary retention, constipation, blurred vision, tachyarrhythmia, drowsiness and cognitive impairment. Age-related decline in cholinergic neurotransmission contributes to increased sensitivity of older patients to anticholinergic effects. The absence of prescription of drugs with beneficial effects, which should be prescribed in elderly patients, represents another issue in gerontopharmacology. This issue occurs more commonly in clinical practice than the potentially inappropriate prescription. Clinical conditions with frequently absenting prescription of beneficial medications are listed in the START criteria.2 This work was supported by grant VEGA 1/0112/17. 1.American Geriatrics Society. J Am Geriatr Soc. 2015; 63 (11): 2227-2246. 2.O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. Age Ageing 2015; 44 (2): 213-218.