Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia , Adelaide, Australia.
Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia , Australia.
Expert Opin Drug Metab Toxicol. 2021 Jan;17(1):41-52. doi: 10.1080/17425255.2021.1839413. Epub 2020 Nov 2.
Age-associated physiological changes can alter the disposition of drugs, however, pathophysiological changes associated with geriatric syndromes in older adults may lead to even greater heterogeneity in pharmacokinetics. Geriatric syndromes are common health problems in older adults which have multifactorial causes and do not fit into distinct organ-based disease categories. With older adults being the greatest users of medications, understanding both age- and geriatric syndrome-related changes is important clinically to ensure safe and effective medication use.
This review provides an overview of current evidence regarding pharmacokinetic alterations that occur with aging and in common geriatric syndromes, including frailty, sarcopenia, dementia, polypharmacy and enteral feeding. The evidence is presented according to the four primary pharmacokinetic processes (Absorption, Distribution, Metabolism and Excretion).
There is some evidence to inform our understanding of the impact of chronological aging and various geriatric syndromes on drug disposition. However, many areas require more research, including drug induced inhibition and induction of cytochrome P450 enzymes and the clinical utility of emerging methods for estimating renal function. There is a need to develop tools to predict alterations in drug disposition in subgroups of older adults, particularly where the currently available clinical information is sparse.
与年龄相关的生理变化会改变药物的分布，但与老年人老年综合征相关的病理生理变化可能导致药代动力学的更大异质性。老年综合征是老年人常见的健康问题，其病因复杂，不符合特定的器官疾病类别。由于老年人是最大的药物使用者，因此了解与年龄和老年综合征相关的变化在临床上对于确保安全有效的药物使用非常重要。
本综述概述了与衰老和常见老年综合征（包括虚弱、肌少症、痴呆、多种药物治疗和肠内喂养）相关的药代动力学改变的现有证据。证据根据四个主要的药代动力学过程（吸收、分布、代谢和排泄）呈现。
有一些证据可以帮助我们了解生理年龄和各种老年综合征对药物处置的影响。然而，许多领域需要更多的研究，包括药物诱导的细胞色素 P450 酶抑制和诱导，以及评估肾功能的新兴方法的临床实用性。需要开发工具来预测老年人群亚组中药物处置的改变，特别是在当前临床信息稀缺的情况下。
