Skip to main content
SpringerLink
Log in

Pharmacology of Aging

  • Reference work entry
  • First Online:
Geriatric Gastroenterology

  • 230 Accesses

Abstract

Managing medication use is one of the most challenging aspects of caring for older adults. This is because the older adult has added variability in their pharmacokinetics, pharmacodynamics, and response to pharmacologic agents beyond the typical variability seen from one person to another. While oral absorption is slowed, for chronic medications no patient concerns occur; however, transdermal absorption may vary considerably in older adults. Distribution varies based upon the hydrophilic and lipophilic drug properties. Metabolism is often slowed, causing drug accumulation in the body. Likewise excretion is usually reduced, further impairing elimination from the body. Although it is well recognized that older adults have altered pharmacokinetic parameters as compared to young, healthy adults, seldom are pharmacokinetic data obtained in this population prior to drug release. Clinical trials for new agents recruit some older adults with co-morbidity; less than 4% of trials included pharmacokinetic evaluations in this group. The lack of data in the geriatric population requires extrapolation of information understood about the group as a whole when starting a new medication followed by cautious and careful monitoring for therapeutic and adverse effects. Beyond the pharmacokinetic issues are concerns with drug exposure. Polypharmacy creates an increased potential for drug-drug, drug-food, and drug-disease interactions. Rational deprescribing requires a stepwise approach to identifying agents that should be discontinued and removing them from the drug regimen in a way as to not create withdrawal or rebound symptoms. This chapter will describe the pharmacokinetic and pharmacodynamics variability usually encountered in older adults as a foundation for consideration in the various gastrointestinal illnesses and their treatment. Medications which may cause or are used in common gastrointestinal illnesses seen in older adults are reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Adelman B, Sandrock A, Panzara MA. Natalizumab and progressive multifocal leukoencephalopathy. N Engl J Med. 2005;353(4):432–3.

    Article  CAS  PubMed  Google Scholar 

  • Agrahari V, Mandal A, Agrahari V, et al. A comprehensive insight on ocular pharmacokinetics. Drug Deliv Transl Res. 2016;6:735–54. https://doi.org/10.1007/s13346-016-0339-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Albuhewa AY, Williams DB, Upton RN, Foster DJR. Food, gastrointestinal pH, and models of oral drug absorption. Eur J Pharm Biopharm. 2017;112:234–48. https://doi.org/10.1016/j.ejpb.2016.11.034.

    Article  CAS  Google Scholar 

  • Ali MA, Lacy BE. Abdominal complaints and gastrointestinal disorders. In: Landefeld CS, Palmer RM, Johnson MA, et al., editors. Current geritric diagnosis and treatment. New York: McGraw-Hill; 2004. p. 220–38.

    Google Scholar 

  • American Geriatrics Society 2019 Beers Criteria® Update Expert Panel. 2019 updated Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67:674–94. https://doi.org/10.1111/jgs.13702.

    Article  Google Scholar 

  • American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American Geriatrics Society. J Am Geriatr Soc. 2012;60:1957–68. https://doi.org/10.1111/j.1532-5415.2012.04187.x.

    Article  PubMed Central  Google Scholar 

  • Anderson GJ, Frazer DM. Current understanding of iron homeostasis. Am J Clin Nutr. 2017;106(Suppl):1559S–66S. https://doi.org/10.3945/ajcn.117.155804.

    Article  PubMed  PubMed Central  Google Scholar 

  • Anti M, Pignataro G, Armuzzi A, et al. Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation. Hepato-Gastroenterology. 1998;45(21):727–32.

    CAS  PubMed  Google Scholar 

  • Aymanns C, Keller F, Maus S, et al. Review on pharmacokinetics and pharmacodynamics and the aging kidney. Clin J Am Soc Nephrol. 2010;5:314–27. https://doi.org/10.2215/CJN.03960609.

    Article  CAS  PubMed  Google Scholar 

  • Azab M, Doo L, Elmofti Y, et al. Comparison of the hospital-acquired Clostridium difficile infection risk of using proton pump inhibitors versus histamine-2 receptor antagonists for prophylaxis and treatment of stress ulcers: a systematic review and meta-analysis. Gut Liver. 2017;11:781–8. https://doi.org/10.5009/gnl16568.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Balzer KM. Drug-induced dysphagia. Int J MS Care. 2000;2:40–50.

    Article  Google Scholar 

  • Basch E, Prestrud AA, Hesketh PJ, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2011;29(31):4189–98.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bemben NM. Deprescribing: an application to medication management in older adults. Pharmacotherapy. 2016;36:774–80.https://doi.org/10.1002/phar.1776.

    Article  PubMed  Google Scholar 

  • Benet LZ, Hoener B. Changes in plasma protein binding have little clinical relevance. Clin Pharmacol Ther. 2002;71:115–21.https://doi.org/10.1067/mcp.2002.121829.

    Article  CAS  PubMed  Google Scholar 

  • Bharucha AE, Pemberton JH, Locke GR 3rd. American Gastroenterological Association technical review on constipation. Gastroenterology. 2013;144(1):218–38.

    Article  PubMed  Google Scholar 

  • Bianchi M, Festa V, Moretti A, et al. Meta-analysis: long-term therapy with rifaximin in the management of uncomplicated diverticular disease. Aliment Pharmacol Ther. 2011;33(8):902–10.

    Article  CAS  PubMed  Google Scholar 

  • Boyce HW. Drug-induced esophageal damage: diseases of medical progress. Gastrointest Endosc. 1998;47(6):547–50.

    Article  PubMed  Google Scholar 

  • Brandt LJ, Prather CM, Quigley EM, Schiller LR, Schoenfeld P, Talley NJ. Systematic review on the management of chronic constipation in North America. Am J Gastroenterol. 2005;100(s1):S5.

    Article  PubMed  Google Scholar 

  • Brown J, Brandl K, Wess J. Muscarinic receptor agonists and antagonists. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s: the pharmacological basis of therapeutics. 13th ed. 2018. New York: McGraw-Hill.

    Google Scholar 

  • Buchner AM, Blonski W, Lichtenstein GR. Update on the management of Crohn’s disease. Curr Gastroenterol Rep. 2011;3:465–74.

    Article  Google Scholar 

  • Bungard TJ, Yakiwchuk E, Foisy M, Brocklebank C. Drug interactions involving warfarin: practice tool and practical management tips. CPJ/RPC. 2011;144:21–34.

    Google Scholar 

  • Buxton IO. Pharmacokinetics: the dynamics of drug absorption, distribution, metabolism, and elimination. In: Brunton LL, Hilal-Dandan R, Knollmann BC, editors. Goodman & Gilman’s: the pharmacological basis of therapeutics. 13th ed. 2018. New York: McGraw-Hill. http://accessmedicine.mhmedical.com/content.aspx?bookid=2189§ionid=166182905. Accessed 11 Jan 2019.

  • Canadian Deprescribing Network. https://www.deprescribingnetwork.ca/professionals Accessed 11 Jan 2019.

  • Carabotti M, Annibale B. Treatment of diverticular disease: an update on latest evidence and clinical implications. Drugs Context. 2018;7:212526.

    Article  PubMed  PubMed Central  Google Scholar 

  • Champagne ET. Low gastric hydrochloric acid secretion and mineral bioavailability. Adv Exp Med Biol. 1989;249:173–84.

    Article  CAS  PubMed  Google Scholar 

  • Chetty M, Johnson TN, Polak S, Salem F, Doki K, Rostami-Hodjegan A. Physiologically based pharmacokinetic modelling to guide drug delivery in older people. Adv Drug Deliv Rev. 2018;135:85–96. https://doi.org/10.1016/j.addr.2018.08.013.

    Article  CAS  PubMed  Google Scholar 

  • Chien JY, Ho RJY. Drug delivery trends in clinical trials and translational medicine: evaluation of pharmacokinetic properties in special populations. J Pharm Sci. 2011;100:53–8. https://doi.org/10.1002/jps.22253.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Choosing Wisely. An initiative of the ABIM Foundation. Clinician lists. http://www.choosingwisely.org/clinician-lists/. Accessed 11 Jan 2019.

  • Comparato G, Pilotto A, Franze A, Franceschi M, Di Mario F. Diverticular disease in the elderly. Dig Dis. 2007;25(2):151–9.

    Article  PubMed  Google Scholar 

  • Cottone M, Kohn A, Daperno M, et al. Advanced age is an independent risk factor for severe infections and mortality in patients given anti-tumor necrosis factor therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol. 2011;9:30–5.

    Article  CAS  PubMed  Google Scholar 

  • Cusack BJ. Pharmacokinetics in older persons. Am J Geriatr Pharmacother. 2004;2:274–302. https://doi.org/10.1016/j.amjopharm2004.12.005.

    Article  CAS  PubMed  Google Scholar 

  • De Giorgio R, Ruggeri E, Stanghellini V, et al. Chronic constipation in the elderly: a primer for the gastroenterologist. BMC Gastr. 2015;15:1–13. https://doi.org/10.1186/s12876-015-0366-3

  • Desai A, Zator ZA, de Silva P, et al. Older age is associated with higher rate of discontinuation of anti-TNF therapy in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:309–15.

    Article  PubMed  Google Scholar 

  • DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005;100:190–200. https://doi.org/10.1111/j.1572-0241.2005.41217.x.

    Article  PubMed  Google Scholar 

  • Dharmarajan TS, Yoo J, Russell RO, Norkus EP. Chronic kidney disease staging in nursing home and community older adults: does the choice of Cockcroft-Gault, modification of diet in renal disease or the chronic kidney disease epidemiology collaboration initiative equations matter? J Am Med Dir Assoc. 2012;13:151–5.

    Article  CAS  PubMed  Google Scholar 

  • Dharmarajan TS, Choi H, Hossain N, et al. Deprescribing as a Clinical Improvement Focus [published online ahead of print, 2019 Oct 28]. J Am Med Dir Assoc. 2019;S1525-8610(19)30648-6. https://doi.org/10.1016/j.jamda.2019.08.031

  • Dowling TC, Wang ES, Ferrucci L, Sorkin JD. Glomerular filtration rate equations overestimate creatinine clearance in older individuals enrolled in the Baltimore Longitudinal Study on Aging (BLSA): impact on renal drug dosing. Pharmacotherapy. 2013;33:912–21. https://doi.org/10.1002/phar.1282.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Edwards LL, Pfeiffer F, Quigley EM, Hofman R, Balluff M. Gastrointestinal symptoms in Parkinson’s disease. Mov Disord. 1991;6(2):151–6.

    Article  CAS  PubMed  Google Scholar 

  • Elisei W, Tursi A. Recent advances in the treatment of colonic diverticular disease and prevention of acute diverticulitis. Ann Gastroenterol. 2016;29(1):24–32.

    PubMed  PubMed Central  Google Scholar 

  • Feagan BG, Sandborn WJ, Gasink C, et al. Ustekinumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2016;375:1946–60.

    Article  CAS  PubMed  Google Scholar 

  • Flake ZA, Linn BS, Hornecker JR. Practical selection of antiemetics in the ambulatory setting. Am Fam Physician. 2015;91:293–6.

    PubMed  Google Scholar 

  • Fleming V, Wade WE. A review of laxative therapies for treatment of chronic constipation in older adults. Am J Geriatr Pharmacother. 2010;8(6):514–50.

    Article  CAS  PubMed  Google Scholar 

  • Floch MH, White JA. Management of diverticular disease is changing. World J Gastroenterol. 2006;12(20):3225–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ford AC, Bernstein CN, Khan KJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106:590–9.

    Article  CAS  PubMed  Google Scholar 

  • Fric P, Zavoral M. The effect of non-pathogenic Escherichia coli in symptomatic uncomplicated diverticular disease of the colon. Eur J Gastroenterol Hepatol. 2003;15:313–5.

    Article  PubMed  Google Scholar 

  • Frytak S, Moertel CH, Childs DS. Neurologic toxicity associated with high-dose metronidazole therapy. Ann Intern Med. 1978;88:361–2.

    Article  CAS  PubMed  Google Scholar 

  • Gallagher P, Ryan C, Byrne S, et al. STOPP (screening tool of older person’s prescriptions) and START (screening tool to alert doctors to right treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46:72–83.

    Article  CAS  PubMed  Google Scholar 

  • Gallegos-Orozco JF, Foxx-Orenstein AE, Sterler SM, Stoa JM. Chronic constipation in the elderly. Am J Gastroenterol. 2012;107(1):18–25.

    Article  PubMed  Google Scholar 

  • Garber C, Plotnikova N, Au SC, Sorensen EP, Gottlieb A. Biologic and conventional systemic therapies show similar safety and efficacy in elderly and adult patients with moderate to severe psoriasis. J Drugs Dermatol. 2015;14(8):846–52.

    PubMed  Google Scholar 

  • Hanley MJ, Cancalon P, Widmer WW, Greenblatt DJ. The effect of grapefruit juice on drug disposition. Expert Opin Drug Metab Toxicol. 2011;7:267–86. https://doi.org/10.1517/17425255.2011.553189.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45:1045–51.

    Article  CAS  PubMed  Google Scholar 

  • Hayashi M, Umezawa Y, Fukuchi O, Ito T, Saeki H, Nakagawa H. Efficacy and safety of ustekinumab treatment in elderly patients with psoriasis. J Dermatol. 2014;41(11):974–80.

    Article  CAS  PubMed  Google Scholar 

  • Jacobs DO. Diverticulitis. N Engl J Med. 2007;357(20):2057–66.

    Article  CAS  PubMed  Google Scholar 

  • Johanson JF, Ueno R. Lubiprostone, a locally acting chloride channel activator, in adult patients with chronic constipation: a double-blind, placebo-controlled, dose-ranging study to evaluate efficacy and safety. Aliment Pharmacol Ther. 2007;25:1351–61.

    Article  CAS  PubMed  Google Scholar 

  • Johanson JF, Morton D, Geenen J, Ueno R. Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of lubiprostone, a locally-acting type-2 chloride channel activator, in patients with chronic constipation. Am J Gastroenterol. 2008;103:170–7.

    Article  CAS  PubMed  Google Scholar 

  • John ES, Katz K, Saxena M, Chokhavatia S, Katz S. Management of inflammatory bowel disease in the elderly. Curr Treat Options Gastroenterol. 2016;14:285–304.

    Article  PubMed  Google Scholar 

  • Juneja M, Maidoo L, Schwartz MB, Barrie A 3rd, Regueiro M, Dunn M, et al. Geriatric inflammatory bowel disease: phenotypic presentation, treatment patterns, nutritional status, outcomes, and comorbidity. Dig Dis Sci. 2012;57:2408–15.

    Article  PubMed  Google Scholar 

  • Kelsen J, Baldassano RN. Inflammatory bowel disease: the difference between children and adults. Inflamm Bowel Dis. 2008;14(Suppl 2):S9–11.

    PubMed  Google Scholar 

  • Khan KJ, Ullman TA, Ford AC, Abreu MT, Abadir A, Marshall JK, Talley NJ, Moayyedi P. Antibiotic therapy in inflammatory bowel disease: a systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):661–73.

    Article  CAS  PubMed  Google Scholar 

  • Kikendall JW. Pill-induced esophagitis. Gastroenterol Hepatol. 2007;3:275–6.

    Google Scholar 

  • Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41:67–76. https://doi.org/10.1080/03602530902722679.

    Article  CAS  PubMed  Google Scholar 

  • Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults: American College of Gastroeneterology, Practice Parameters Committee. Am J Gastroenterol. 2010;105:501–23.

    Article  PubMed  Google Scholar 

  • Lakshmi Prasanna PJ, Deepthi B, Rama Rao N. Rectal drug delivery: a promising route for enhancing drug absorption. Asian J Res Pharm Sci. 2012;2:143–9.

    Google Scholar 

  • Leiman DA, Riff BP, Morgan S, et al. Alginate therapy is effective treatment for GERD symptoms: a systematic review and meta-analysis. Dis Esophagus. 2017;30:1–9. https://doi.org/10.1093/dote/dow020.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lembo AJ, Kurtz CB, Macdougall JE, et al. Efficacy of linaclotide for patients with chronic constipation. Gastroenterology. 2010;138:886–95.

    Article  CAS  PubMed  Google Scholar 

  • Liang X, Giacomini KM. Transporters involved in metformin pharmacokinetics and treatment response. J Pharm Sci. 2017;106:2245–50. https://doi.org/10.1016/j.xphs.2017.04.078.

    Article  CAS  PubMed  Google Scholar 

  • Lichtenstein GR, Hanauer SB, Sandborn WJ. Management of Crohn’s disease in adults. Am J Gastroenterol. 2009;104:465–83.

    Article  PubMed  Google Scholar 

  • Lobaton Ortega T, Vermeire S, Ballet V, et al. Elderly patients with inflammatory bowel disease under anti-TNF therapy: efficacy and safety. J Crohns Colitis. 2014;8(Suppl 1):S273.

    Article  Google Scholar 

  • Loftus EV, Silverstein MD, Sandborn WJ, et al. Crohn’s disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology. 1998;114:1161–8.

    Article  PubMed  Google Scholar 

  • Loftus EV, Silverstein MD, Sandborn WJ, et al. Ulcerative colitis in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gut. 2000;46:336–43.

    Article  PubMed  PubMed Central  Google Scholar 

  • MacIsaac RJ, Ekinci EI, Premaratne E, al e. The Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation does not improve the underestimation of glomerular filtration rate (GFR) in people with diabetes and preserved renal function. BMC Nephrol. 2015;16:198–211. https://doi.org/10.1186/s12882-015-0196-0.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2003;57:6–14. https://doi.org/10.1046/j.1365-2125.2003.02007.x.

    Article  CAS  Google Scholar 

  • Masnoon N, Shakib S, Kalisch-Ellett CGE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230–40. https://doi.org/10.1186/s12877-017-0621-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • McLachlin AJ, Pont LG. Drug metabolism in older people – a key consideration in achieving optimal outcomes with medicines. J Gerontol A Biol Sci Med Sci. 2012;67A:175–80. https://doi.org/10.1093/gerona/glr118.

    Article  CAS  Google Scholar 

  • Mendoza J, Legido J, Rubio S, Gisbert JP. Systematic review: the adverse effects of sodium phosphate enema. Aliment Pharmacol Ther. 2007;26(1):9–20.

    Article  CAS  PubMed  Google Scholar 

  • Miller JW. Proton pump inhibitors, H2-receptor antagonists, metformin, and vitamin B-12 deficiency: clinical implications. Adv Nutr. 2018;9:511S–8S. https://doi.org/10.1093/advances/nmy023.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mungan Z, Simsek BP. Which drugs are risk factors for the development of gastroesophageal reflux disease? Turk J Gastroenterol. 2017;28(S 1):S39–43. https://doi.org/10.5152/tjg.2017.11.

    Article  Google Scholar 

  • National Institute of Diabetes and Digestive and Kidney Diseases. Estimating glomerular flitration rate. https://www.niddk.nih.gov/health-information/communication-programs/nkdep/laboratory-evaluation/glomerular-filtration-rate/estimating#the-mdrd-equation. Accessed 11 Jan 2019.

  • National Kidney Foundation. CKD-EPI Creatinine equation. 2009. https://www.kidney.org/content/ckd-epi-creatinine-equation-2009. Accessed 3 Oct 2019.

  • Nyberg C, Hendel J, Nielsen OH. The safety of osmotically acting cathartics in colonic cleansing. Nat Rev Gastroenterol Hepatol. 2010;7(10):557–64.

    Article  PubMed  Google Scholar 

  • O’Mahoney D, O’Sullivan D, Byrne S, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44:213–8. https://doi.org/10.1093/ageing/afu145.

    Article  Google Scholar 

  • Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. BMJ. 1971;ii:450–4.

    Article  Google Scholar 

  • Painter NS, Burkitt DP. Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol. 1975;4:3–21.

    Article  CAS  PubMed  Google Scholar 

  • Paré P, Fedorak RN. Systematic review of stimulant and nonstimulant laxatives for the treatment of functional constipation. Can J Gastroenterol Hepatol. 2014;28(10):549–57.

    Article  PubMed  PubMed Central  Google Scholar 

  • Poh CH, Navarro-Rodriguez T, Fass R. Review: treatment of gastroesophageal reflux disease in the elderly. Am J Med. 2010;123:496–501. https://doi.org/10.1016/j.amjmed.2009.07.036.

    Article  PubMed  Google Scholar 

  • Raman M, Middleton RJ, Kalra PA, Green D. Estimating renal function in old people: an in-depth review. Int Urol Nephrol. 2017;49:1979–88. https://doi.org/10.1007/s11255-017-1682-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ramkumar D, Rao SS. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol. 2005;100(4):936–71.

    Article  PubMed  Google Scholar 

  • Rao SS, Quigley EM, Shiff SJ, et al. Effect of linaclotide on severe abdominal symptoms in patients with irritable bowel syndrome with constipation. Clin Gastroenterol Hepatol. 2014;12:616–23.

    Article  CAS  PubMed  Google Scholar 

  • Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ. 1997;315:1096–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Saha JR, Butler VP Jr, Neu HC, Lindenbaum J. Digoxin-inactivating bacteria: identification in human gut flora. Science. 1983;220:325–7.

    Article  CAS  PubMed  Google Scholar 

  • Sandborn WJ, Rutgeerts P, Gasink C, et al. Long-term efficacy and safety of ustekinumab for Crohn’s disease through the second year of therapy. Aliment Pharmacol Ther. 2018;48(1):65–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schuster BG, Kosar L, Kamrul R. Constipation in older adults: stepwise approach to keep things moving. Can Fam Physician. 2015;61(2):152–8.

    PubMed  PubMed Central  Google Scholar 

  • Scott IA, Gray LC, Martin JH, Mitchell CA. Minimizing inappropriate medictions in older populations: a 10-step conceptual framework. Am J Med. 2012;125:529–37.

    Article  PubMed  Google Scholar 

  • Singh P, Yoon SS, Kuo B. Nausea: a review of pathophysiology and therapeutics. Ther Adv Gastroenterol. 2016;9:98–112. https://doi.org/10.1177/1756283X15618131.

    Article  CAS  Google Scholar 

  • Slavin J. Fiber and prebiotics: mechanisms and health benefits. Nutrients. 2013;5(4):1417–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Soler D, Chapman T, Yang LL, Wyant T, Egan R, Fedyk ER. The binding specificity and selective antagonism of vedolizumab, an anti-α4β7 integrin therapeutic antibody in development for inflammatory bowel diseases. J Pharmacol Exp Ther. 2009;330(3):864–75.

    Article  CAS  PubMed  Google Scholar 

  • Spence MM, Karim FA, Lee EA, Hui RL, Gibbs NE. Risk of injury in older adults using gastrointestinal antispasmodic and anticholinergic medications. J Am Geriatr Soc. 2015;63(6):1197–202.

    Article  PubMed  Google Scholar 

  • Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimized? Lancet. 2007;370:173–84. https://doi.org/10.1016/S0140-6736(07)61091-5.

    Article  PubMed  Google Scholar 

  • Stahlmann R, Lode H. Safety considerations of fluoroquinolones in the elderly: an update. Drugs Aging. 2010;27:193–209.

    Article  PubMed  Google Scholar 

  • Thomas TP. The complications of systemic corticosteroid therapy in the elderly. A retrospective study. Gerontology. 1984;30(1):60–5.

    Article  CAS  PubMed  Google Scholar 

  • Tursi A, Brandimarte G, Giorgetti GM, Elisei W. Mesalazine and/or Lactobacillus casei in preventing recurrence of symptomatic uncomplicated diverticular disease of the colon: a prospective, randomized, open-label study. J Clin Gastroenterol. 2006;40(4):312–6.

    Article  PubMed  Google Scholar 

  • Tursi A, Brandimarte G, Giorgetti GM, Elisei W, Aiello F. Balsalazide and/or high-potency probiotic mixture (VSL#3) in maintaining remission after attack of acute, uncomplicated diverticulitis of the colon. Int J Color Dis. 2007;22(9):1103–8.

    Article  Google Scholar 

  • Tursi A, Brandimarte G, Giorgetti GM, Elisei W. Mesalazine and/or Lactobacillus casei in maintaining long-term remission of symptomatic uncomplicated diverticular disease of the colon. Hepato-Gastroenterology. 2008;55(84):916–20.

    PubMed  Google Scholar 

  • Tursi A, Papa A, Danese S. The pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Aliment Pharmacol Ther. 2015;42(6):664–84.

    Article  CAS  PubMed  Google Scholar 

  • U.S. Department of Health and Human Services; U.S. Department of Agriculture; U.S. Dietary Guidelines Advisory Committee. Dietary guidelines for Americans, 2010. 7th ed. Washington, DC: U.S. Government Printing Office; 2010.

    Google Scholar 

  • Ãœnlü C, Daniels L, Vrouenraets BC, Boermeester MA. A systematic review of high-fibre dietary therapy in diverticular disease. Int J Color Dis. 2012;27(4):419–27.

    Article  Google Scholar 

  • Van Assche G, Van Ranst M, Sciot R, et al. Progressive multifocal leukoencephalopathy after natalizumab therapy for Crohn’s disease. N Engl J Med. 2005;353(4):362–8.

    Article  PubMed  Google Scholar 

  • Wells PS, Holbrook AM, Crowther NR, Hirsh J. Interactions of warfarin with drugs and food. Ann Intern Med. 1994;121(9):676–83.

    Article  CAS  PubMed  Google Scholar 

  • Won CS, Oberlies NH, Paine MF. Influence of dietary substances on intestinal drug metabolism and transport. Curr Drug Metab. 2010;11:778–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yajnik V, Khan N, Dubinsky M, et al. Efficacy and safety of vedolizumab in ulcerative colitis and Crohn’s disease patients stratified by age. Adv Ther. 2017;34(2):542–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ye X, Liu H, Wu C, et al. Proton pump inhibitors therapy and risk of hip fracture: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2011;23:794–800. https://doi.org/10.1097/MEG.0b013e328348a56a.

    Article  CAS  PubMed  Google Scholar 

  • Yeung S, Traini D, Lewis D, Young PM. Dosing challenges in respiratory therapies. Int J Pharm. 2018;548:659–71. https://doi.org/10.1016/j.ijpharm.2018.07.007.

    Article  CAS  PubMed  Google Scholar 

  • Yu C, Giuffre B. Achilles tendinopathy after treatment with fluoroquinolone. Australas Radiol. 2005;49:407–10.

    Article  CAS  PubMed  Google Scholar 

  • Yu J, Zhou Z, Tay-Sontheimer J, Levy RH. Intestinal drug interactions mediated by OATPs: a systematic review of preclinical and clinical findings. J Pharm Sci. 2017;2312–25. https://doi.org/10.1016/j.xphs.2017.04.004

  • Zografos GN, Deorgiadou D, Thomas D, Kaltsas G. Drug-induced esophagitis. Dis Esophagus. 2009;22:633–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. College of Pharmacy and College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Lisa C. Hutchison

Authors
  1. Lisa C. Hutchison
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa C. Hutchison .

Editor information

Editors and Affiliations

  1. Department of Medicine, Robert Wood Johnson School of Medicine, Rutgers University, New Brunswick, NJ, USA

    C. S. Pitchumoni

  2. Department of Medicine, Division of Geriatrics, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA

    T.S. Dharmarajan

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Hutchison, L.C. (2021). Pharmacology of Aging. In: Pitchumoni, C.S., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-030-30192-7_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-30192-7_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-30191-0

  • Online ISBN: 978-3-030-30192-7

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation