Istituto Nazionale di Ricovero, e Cura per Anziani (INRCA), C.da Muoio Piccolo, I-87100 Cosenza, Italy.
Curr Med Chem. 2010;17(6):571-84. doi: 10.2174/092986710790416326.
Aging is known to be associated with an increased prevalence of multiple chronic diseases, which frequently causes the use of complex therapeutic regimens. The aging process is characterized by relevant changes in drug handling, physiological reserve, and pharmacodynamic response. Hepatic drug clearance of several drugs decreases with aging, mainly due to reduced blood flow, and hepatocyte mass. Renal function also declines with aging, mainly due to sclerotic changes in the glomeruli. Furthermore, due to reduced muscle mass, older subjects frequently have depressed glomerular filtration rate despite normal serum creatinine, and such a concealed renal insufficiency may impact significantly the clearance of hydrosoluble drugs. Changes in pharmacodynamics are also well documented in the cardiovascular and nervous system. Age-related changes in pharmacokinetics and pharmacodynamics, together with comorbidity and polypharmacy, make elderly patients at special risk for adverse drug reactions, which in turn are cause of relevant health burden and costs. Selected measures can assist in preventing or detecting timely such adverse events.
衰老是多种慢性疾病高发的相关因素，这常常导致复杂的治疗方案的应用。衰老过程的特点是药物处理、生理储备和药效反应方面的相关变化。几种药物的肝清除率随年龄增长而降低，主要是由于血流量减少和肝细胞质量减少。肾功能也随年龄增长而下降，主要是由于肾小球发生硬化性改变。此外，由于肌肉质量减少，尽管血清肌酐正常，老年人的肾小球滤过率往往较低，这种隐匿性肾功能不全可能会显著影响水溶性药物的清除率。在心血管和神经系统中也有充分的药效学变化记录。与年龄相关的药代动力学和药效学变化，加上合并症和多种药物治疗，使老年患者特别容易发生药物不良反应，而这些不良反应反过来又导致了相关的健康负担和费用。一些措施可以帮助预防或及时发现这些不良事件。
