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衰老对老年患者长期用药药效学和药代动力学的影响:综述

Influence of Ageing on the Pharmacodynamics and Pharmacokinetics of Chronically Administered Medicines in Geriatric Patients: A Review.

作者信息

Ngcobo Nokwanda N

机构信息

Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

出版信息

Clin Pharmacokinet. 2025 Mar;64(3):335-367. doi: 10.1007/s40262-024-01466-0. Epub 2025 Jan 11.

Abstract

As people age, the efficiency of various regulatory processes that ensure proper communication between cells and organs tends to decline. This deterioration can lead to difficulties in maintaining homeostasis during physiological stress. This includes but is not limited to cognitive impairments, functional difficulties, and issues related to caregivers which contribute significantly to medication errors and non-adherence. These factors can lead to higher morbidity, extended hospital stays, reduced quality of life, and even mortality. The decrease in homeostatic capacity varies among individuals, contributing to the greater variability observed in geriatric populations. Significant pharmacokinetic and pharmacodynamic alterations accompany ageing. Pharmacokinetic changes include decreased renal and hepatic clearance and an increased volume of distribution for lipid-soluble drugs, which prolong their elimination half-life. Pharmacodynamic changes typically involve increased sensitivity to various drug classes, such as anticoagulants, antidiabetic and psychotropic medications. This review examines the primary age-related physiological changes in geriatrics and their impact on the pharmacokinetics and pharmacodynamics of medications.

摘要

随着人们年龄的增长,确保细胞与器官之间正常通讯的各种调节过程的效率往往会下降。这种衰退会导致在生理应激期间难以维持体内平衡。这包括但不限于认知障碍、功能困难以及与护理人员相关的问题,这些问题会显著导致用药错误和不依从性。这些因素会导致更高的发病率、更长的住院时间、生活质量下降甚至死亡。体内平衡能力的下降在个体之间存在差异,这导致老年人群体中观察到的变异性更大。衰老伴随着显著的药代动力学和药效学改变。药代动力学变化包括肾脏和肝脏清除率降低以及脂溶性药物的分布容积增加,这延长了它们的消除半衰期。药效学变化通常涉及对各种药物类别(如抗凝剂、抗糖尿病药物和精神药物)的敏感性增加。本综述探讨了老年医学中与年龄相关的主要生理变化及其对药物药代动力学和药效学的影响。

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