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Older patients require lower doses of drugs

SAN DIEGO, CALIFORNIA. Adverse drug reactions (ADRs) are a serious problem in the United States and in many other developed countries. More than two million serious ADRs occurred in the USA in 1994 of which 76,000 to 137,000 were fatal. It is estimated that 76 per cent of these ADRs were due to drug overdosing. The doses given in many cases followed the manufacturer's recommendation, but just happened to be excessive for the particular patient being treated. Dr. Jay Cohen, MD of the University of California points out that over half of all ADRs involve patients age 60 years and older. He believes this is largely because older patients metabolize many drugs slower than do younger patients and therefore end up with higher systemic levels which may precipitate an ADR. He also points out that the Physicians' Desk Reference used by many medical doctors when prescribing drugs rarely recommends lower dosages for older patients - in other words, one dose fits all!

Dr. Cohen has reviewed numerous studies that clearly show that reduced doses of many popular drugs are entirely adequate and much safer for older patients. For example, the stomach drug omeprazole (Losec) is cleared from the system much slower in older people and particularly in older people of Asian descent. He suggests that 10 mg/day of this drug may be quite adequate in older people (standard dosage is 20 mg/day). Fluoxetine (Prozac) is well known for causing sexual dysfunction at its standard dose of 20 mg/day in about 34 to 74 per cent of patients taking it. Studies have shown that this effect can be eliminated without affecting the antidepressant effect by reducing the dose to 10 mg/day; as a matter of fact, dosages as low as 2.5 mg/day may be quite effective in older people. Other studies have shown that as little as 10 mg of sildenafil (Viagra) may do the trick and yet the recommended dosages are 25, 50 and 100 mg. Dr. Cohen lists many other drugs where reduced dosages are quite adequate and much safer. For example, Celebrex 5 mg twice daily instead of 10 mg twice daily, lovastatin (Mevacor) 10 mg/day instead of 20 mg/day, and simvastatin (Zocor) 5 to 10 mg per day instead of the recommended dose of 20 mg/day. Nonsteroidal anti-inflammatory drugs (NSAIDs) are significant contributors to ADRs resulting in more than 100,000 hospitalizations and between 8,000 and 16,000 deaths every year in the USA alone. Studies involving diclofenac (Voltaren) and ibuprofen have shown that older people receive the same effects from half the dose recommended for younger people. Dr. Cohen concludes that "little is lost and much may be gained" by starting older people off at low yet effective drug doses.
Cohen, Jay S. Avoiding adverse reactions - Effective lower-dose drug therapies for older patients. Geriatrics, Vol. 55, February 2000, pp. 54-64

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