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Chapter 2 – Medication use

Rebecca J. Beyth, M.D., M.Sc.,
Ronald I. Shorr, M.D., M.S.

Summary Points for the Primary Care Physician

  •    In older persons, the relative increase in body fat and the decrease in lean body mass alter drug distribution so that fat-soluble drugs are distributed more widely and water-soluble drugs are distributed less widely.
  •    The cytochrome P450 (CYP3A) hepatic metabolism of medications may result in a new medication causing a dangerous side effect of another medication, which was previously safely prescribed.
  •    An important pharmacokinetic change that occurs in persons of advanced age is that of reduced renal drug elimination.
  •    The sensitivity to drug side effects may either increase or decrease with increasing age.
  •    The physician must understand that protocol medicine may not be relevant to a heterogeneous older population.
  •    Nonadherence to medications is more common in older patients because they simply are prescribed more medications than younger patients.
  •    Poor communication …



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