Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département de gériatrie, 75013 Paris, France.
Sorbonne Université, Assistance Publique Hôpitaux de Paris, Regional Pharmacovigilance Center, Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France.
Rev Neurol (Paris). 2020 Nov;176(9):710-723. doi: 10.1016/j.neurol.2019.11.010. Epub 2020 May 8.
Older people are often exposed to polypharmacy in a multimorbidity context. Inappropriate polypharmacy is often harmful, increasing the risk of inappropriate prescriptions and therefore adverse drug events (ADEs). Five to 20% of all hospital admissions are related to ADE in older people, among which 40 to 70% could be prevented. However, identifying ADEs and drug-related admissions in the elderly is challenging because ADEs often present as common geriatric problems such as falls, delirium, which might be due to the aging process, underlying diseases, and/or medications. In the pharmacovigilance database of the World Health Organization, drug-related neurological manifestations are the third reported cause of ADEs in the elderly, and neurological drugs are the third leading class of medications involved in ADEs. We must therefore be particularly vigilant, both in our prescriptions but also in our diagnoses to avoid prescribing inappropriate treatments and detect ADEs. Even though multiple pharmacologic changes occur in the elderly (absorption, distribution, drug metabolism and excretion), most of medications are still often prescribed at the same daily dosage as in young adults. When prescribing any drug for old patients, we should remember that daily intake should be adapted to these specificities, keeping in mind the old well-known aphorism "start low, go slow". In this review, we describe the main drug-related neurological manifestations (drug-induced movement disorders, falls, seizures, delirium, hypoglycemia, stroke, hyponatremia, peripheral neuropathy and myopathy, and serotonin syndrome) and the main drugs associated with neurological manifestations (dopamine receptor blocking agents, antithrombotics, anticholinergics, beta-lactams, antidepressants, benzodiazepines, mood stabilizers).
老年人在患有多种疾病的情况下常常面临多种药物治疗。不适当的多药治疗往往是有害的，会增加不适当处方的风险，从而导致药物不良事件（ADE）。老年人中，5%至 20%的住院治疗与 ADE 相关，其中 40%至 70%可以预防。然而，识别老年人中的 ADE 和与药物相关的住院治疗具有挑战性，因为 ADE 通常表现为常见的老年病问题，如跌倒、谵妄，这些问题可能是由于衰老过程、潜在疾病和/或药物引起的。在世界卫生组织的药物警戒数据库中，药物相关的神经表现是老年人报告的第三大 ADE 原因，神经药物是涉及 ADE 的第三大药物类别。因此，我们必须特别警惕，既要注意我们的处方，也要注意我们的诊断，以避免开出不适当的治疗方法并发现 ADE。尽管老年人会出现多种药物代谢变化（吸收、分布、药物代谢和排泄），但大多数药物仍经常按照与年轻人相同的日剂量开处方。当为老年患者开任何药物时，我们应该记住，每日摄入量应适应这些特殊性，牢记古老的名言“从低剂量开始，逐渐增加”。在这篇综述中，我们描述了主要的药物相关神经表现（药物引起的运动障碍、跌倒、癫痫发作、谵妄、低血糖、中风、低钠血症、周围神经病和肌病以及 5-羟色胺综合征）和与神经表现相关的主要药物（多巴胺受体阻滞剂、抗血栓药物、抗胆碱能药物、β-内酰胺类抗生素、抗抑郁药、苯二氮䓬类药物、心境稳定剂）。
