Unique Physiologic Considerations

  • Nina M. Bemben
  • Mary Lynn McPhersonEmail author


The aging process involves physiologic changes that impact both the disposition and effect of drugs in the body as well as the pathology of pain. As the population ages, an understanding of these principles is essential to recognizing patients in pain and treating their symptoms effectively and appropriately. In this chapter, age-related physiologic changes and their impact on drug pharmacokinetics and pharmacodynamics will be discussed.


Aging Drug effects Pain Age-related physiologic changes Pharmacokinetics Pharmacodynamics 


  1. 1.
    Gibson SJ. In: Dostrovsk JO, Carr DB, Kaltenzburg M, editors. Proceedings of the 10th world congress on pain, progress in pain research and management. Vol. 24. Seattle, WA: IASP Press; 2003. p. 767–90.Google Scholar
  2. 2.
    Kaye AD, Baluch A, Scott JT. Pain management in the elderly population: a review. Ochsner J. 2010;10:179–87.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Davis MP, Srivastava M. Demographics, assessment and management of pain in the elderly. Drugs Aging. 2003;20(1):23–57.CrossRefGoogle Scholar
  4. 4.
    Morrone FB, Schroeter G, Petitembert AP, et al. Potential interactions of central nervous system drugs used in the elderly population. BJP. 2009;45(2):227–33.Google Scholar
  5. 5.
    Holmgaar R, Benfeldt E, Sorensen JA, et al. Chronological age affects the permeation of fentanyl through human skin in vitro. Skin Pharmacol Physiol. 2013;26:155–9.CrossRefGoogle Scholar
  6. 6.
    Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41(2):67–76.CrossRefGoogle Scholar
  7. 7.
    Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol. 2003;38:843–53.CrossRefGoogle Scholar
  8. 8.
    Mercadante S, Arcuri E. Pharmacological management of cancer pain in the elderly. Drugs Aging. 2007;24(9):761–76.CrossRefGoogle Scholar
  9. 9.
    Rowland M, Tozer TN. Clinical pharmacokinetics concepts and applications. 3rd ed. Philadelphia: Lippincott Williams & Williams; 1995.Google Scholar
  10. 10.
    Duragesic Prescribing Information. Accessed 27 Sept 2013.
  11. 11.
    Scully C. Drug effects on salivary glands: dry mouth. Oral Dis. 2003;9:165–76.CrossRefGoogle Scholar
  12. 12.
    Reisner L. Pharmacological management of persistent pain in older persons. J Pain. 2011;12(3):S21–9.CrossRefGoogle Scholar
  13. 13.
    Trescot AM, Datta S, Lee M, et al. Opioid pharmacology. Pain Physician. 2008;11:S133–53.PubMedGoogle Scholar
  14. 14.
    Cavalieri TA. Management of pain in older adults. JAOA. 2005;105(3):S12–7.PubMedGoogle Scholar
  15. 15.
    Smith H, Bruckenthal P. Implications of opioid analgesia for medically complicated patients. Drugs Aging. 2010;27(5):417–33.CrossRefGoogle Scholar
  16. 16.
    The American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.CrossRefGoogle Scholar
  17. 17.
    Koper D, Kamenski G, Flamm M, et al. Frequency of medication errors in primary care patients with polypharmacy. Fam Pract. 2013;30:313–9.CrossRefGoogle Scholar
  18. 18.
    Zhao J, Xin X, Xie G, et al. Molecular and cellular mechanisms of the age-dependency of opioid analgesia and tolerance. Mol Pain. 2012;10(38):1–12.Google Scholar
  19. 19.
    Buntin-Mushock C, Phillip L, Moriyama K, et al. Age-dependent opioid escalation in chronic pain patients. Anesth Analg. 2005;100(6):1740–5.CrossRefGoogle Scholar
  20. 20.
    Kugler JP, Hustead T. Hyponatremia and hypernatremia in the elderly. Am Fam Physician. 2000;61(12):3623–30.PubMedGoogle Scholar
  21. 21.
    Lea M, Rognan SE, Koristovic R, et al. Severity and management of drug-drug interactions in acute geriatric patients. Drugs Aging. 2013;30:721–7.CrossRefGoogle Scholar
  22. 22.
    McPherson ML. Frequent pharmacological interactions. In: Oxford American handbook of hospice and palliative medicine. New York: Oxford UP; 2011. p. 314–32. Print.Google Scholar
  23. 23.
    Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352(11):1112–20.CrossRefGoogle Scholar
  24. 24.
    Liu WQ, Kanungo A, Toth C. Equivalency of tricyclic antidepressants in open-label neuropathic pain study. Acta Neurol Scand. 2013;129(2):132–41.CrossRefGoogle Scholar
  25. 25.
    U.S. Food and Drug Administration. FDA News Release: Xanodyne agrees to withdraw propoxyphene from the U.S. market. Nov. 19, 2010. Accessed 28 Sept 2013.
  26. 26.
    U.S. Food and Drug Administration. Recent FDA actions on NSAIDs. FDA patient safety news: show #40 2005. Accessed 28 Sept 2013.
  27. 27.
    Butrans Prescribing Information. Accessed 27 Sept 2013.
  28. 28.
    McPherson ML, Cimino NM. Topical NSAID formulations. Pain Med. 2013;14:S25–9.CrossRefGoogle Scholar
  29. 29.
  30. 30.
  31. 31.
  32. 32.

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Kaiser PermanenteOaklandUSA
  2. 2.Department of Pharmacy Practice and ScienceUniversity of Maryland School of PharmacyBaltimoreUSA

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