As there are no simple rules for dermatological drug dosing in the elderly, titrate to suit individual response
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As there are no simple rules for dermatological drug dosing in the elderly, titrate to suit individual response Elderly patients are more likely to experience adverse drug reactions than younger adults, largely because of age-related changes to pharmacokinetics, existing comorbidities and multidrug regimens. Dermatological drugs that are predominantly eliminated by the kidney may be eliminated more slowly in the elderly and, therefore, dose reduction should be considered. Potentially hepatotoxic dermatological drugs should be used with caution in the elderly.
Elderly at high risk To provide elderly patients (generally those aged >65 years) with optimal medication and dosages, specific agerelated changes should be considered (tables I and II). In Table I. Considerations when prescribing selected dermatological drugs in elderly patients (pts)[1,3-5] Drug
Comment
Acitretin
Reduce dose in pts with liver disease
Cetirizine
Reduce dose by 50% in pts with decreased renal function
Ciprofloxacin
Inhibits metabolism of theophylline by CYP1A2 May result in theophylline accumulation and toxicity May increase risk of developing seizures
Corticosteroids (oral)
Elderly may be more susceptible to memory impairment Increases risk of developing diabetes mellitus Increases risk of peptic ulcer disease in pts who are receiving NSAIDs concurrently
Diphenhydramine Increased risk of cognitive impairment Erythromycin
Strong inhibitor of CYP3A4 May lead to increased toxicity of some coadministered drugs (e.g. benzodiazepines, calcium channel antagonists, ciclosporin, tacrolimus and warfarin)
Hydroxyzine
Prolonged half-life Possible increase in receptor sensitivity
Itraconazole
Use with caution in pts with a history of liver impairment
Methotrexate
Serious potential for adverse effects in pts with decreased renal function Contraindicated in pts with severe renal impairment (glomerular filtration rate 65 years) prescribed a drug primarily excreted in the
urine, 45% received larger dosages than those recommended by the manufacturer.[14] … so reduce dosage of some drugs
In elderly patients with diminished renal function, dosage reduction is recommended for any drug that is predominantly eliminated by the kidney.[1] Therapeutic drug levels can be maintained by reducing the dose or by increasing the interval between doses or both.[3] Relatively low dosages of methotrexate should be used in elderly patients with reduced renal function.[1,10] As methotrexate is excreted principally by the kidneys and its half-life is increased markedly in patients with impaired renal function, its use in this patient population may result in accumulation of toxic amounts or additional renal damage. The clearance of methotrexate may also be reduced when it is coadministered with NSAIDs.[1] Cetirizine is also primarily excreted in the urine.[1,10] In patients with renal impairment, an ≈50% reduction in the dosage of cetirizine or the use of another secondgeneration antihistamine (e.g. fexofenadine) is recommended.[1]
Decrease in hepatic clearan
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