Lower doses should be considered in the elderly for all medicines.


General Advice

  • When prescribing, ‘start low and go slow’; adjust dose in relation to renal and metabolic function.
  • Reduce polypharmacy.
  • Review all medicines frequently, use minimum dose required for effect, and discontinue unnecessary medicines.
  • Consider patient non-adherence and utilise appropriate dosage forms (e.g. for swallowing difficulties) and compliance aids e.g. blister packs.
  • Give clear instruction on use to ensure the patient/care-giver understands the treatment plan.


Pharmacokinetic Problems

  • Impaired renal and hepatic drug clearance.
  • Both renal function and drug metabolism decline by approximately 1% per year after the age of 40 years.


Pharmacodynamic Problems

  • Altered sensitivity (mostly increased) to most drugs resulting in:
    • adverse drug reactions (ADRs), e.g. CNS medicines
    • Impaired ability to compensate for increased effects, e.g. antihypertensives
    • Increased susceptibility to toxicities, e.g. NSAID nephrotoxicity