Key concepts in geriatric psychopharmacology. Altered pharmacokinetics and polypharmacy.

Certain general principles should be considered whenever psychotropic drugs are prescribed to elderly patients. 1. The aging body usually responds to psychotropic drugs with a prolonged and heightened effect. 2. Before prescribing a psychotropic drug, it is necessary to determine all other medications an older patient is taking, including medications from other physicians as well as self-prescribed, over-the-counter preparations. 3. A careful assessment of the physical health of the patient must be completed before drug treatment begins. 4. The possibility of psychotropic drug toxicity should be considered in any older patient who is taking a psychotropic drug and who appears restless, agitated, confused, forgetful, or depressed. Doses of psychotropic drug should be reduced or the drug discontinued before adding another drug the the regimen. 5. Psychiatric drugs with simple metabolic pathways, particularly tricyclic antidepressants (secondary amines) and short-acting benzodiazepines, are preferred in elderly patients.