Pharmacokinetics and Drug Interactions in the Elderly and Special Issues in Elderly African-American Populations

Workshop Summary

Committee on Pharmacokinetics and Drug Interactions in the Elderly

Division of Neuroscience and Behavioral Health Division of Health Sciences Policy

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C. 1997



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Pharmacokinetics and Drug Interactions in the Elderly and Special Issues in Elderly African-American Populations: Workshop Summary Pharmacokinetics and Drug Interactions in the Elderly and Special Issues in Elderly African-American Populations Workshop Summary Committee on Pharmacokinetics and Drug Interactions in the Elderly Division of Neuroscience and Behavioral Health Division of Health Sciences Policy INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1997

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Pharmacokinetics and Drug Interactions in the Elderly and Special Issues in Elderly African-American Populations: Workshop Summary NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W.Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this project was provided by the National Institute on Aging, National Institutes of Health, under Contract No. N01-OD-4-2139. The views presented are those of the Institute of Medicine Committee on Pharmacokinetics and Drug Interactions in the Elderly and are not necessarily those of the funding organization. International Standard Book No. 0-309-05892-9 Additional copies of this report are available for sale from the National Academy Press, Box 285, 2101 Constitution Avenue, N.W., Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP's on-line bookstore at http://www.nap. edu. Copyright 1997 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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Pharmacokinetics and Drug Interactions in the Elderly and Special Issues in Elderly African-American Populations: Workshop Summary COMMITTEE ON PHARMACOKINETICS AND DRUG INTERACTIONS IN THE ELDERLY LESLIE Z. BENET* (Chair), Professor and Chairman, Department of Biopharmaceutical Sciences, University of California, San Francisco MARK H. BEERS, Senior Director of Geriatrics, Merck & Co., Inc., West Point, Pennsylvania D. CRAIG BRATER, Chairman, Department of Medicine, Director, Division of Clinical Pharmacology, Indiana University School of Medicine DAVID J. GREENBLATT, Professor and Chairman, Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine PATRICIA D. KROBOTH, Professor and Chair, Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy HENRI R. MANASSE, JR.,* Executive Vice President, American Society of Health-System Pharmacists, Bethesda, Maryland MARK MONANE, Director, Disease State Management—Geriatrics, Merck Medco Managed Care, Montvale, New Jersey BRUCE POLLOCK, Professor of Psychiatry and Pharmacology and Director, Geriatric Psychopharmacology Program, University of Pittsburgh School of Medicine JANICE B. SCHWARTZ, Professor of Medicine and Chief of Clinical Pharmacology and Geriatric Medicine, Northwestern University Medical School ROBERT TAYLOR, Chairman, Department of Pharmacology, Howard University College of Medicine RAYMOND WOOSLEY, Chairman, Department of Pharmacology, Georgetown University Medical Center Institute of Medicine Staff CATHARYN T. LIVERMAN, Study Director CAROLYN E. FULCO, Study Director CARRIE E. INGALLS, Research Associate THOMAS WETTERHAN, Administrative Assistant/Research Assistant AMELIA MATHIS, Project Assistant CONSTANCE PECHURA, Director, Division of Neuroscience and Behavioral Health VALERIE P. SETLOW, Director, Division of Health Sciences Policy * Member, Institute of Medicine.

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Pharmacokinetics and Drug Interactions in the Elderly and Special Issues in Elderly African-American Populations: Workshop Summary Contents  1   INTRODUCTION   1      Definitions,   2      Demographics,   3      Comorbidity and Polypharmacy,   4      Report Outline,   5      Acknowledgments,   5  2   WORKSHOP ON PHARMACOKINETICS AND DRUG INTERACTIONS IN THE ELDERLY AND SPECIAL ISSUES IN ELDERLY AFRICAN-AMERICAN POPULATIONS   7      Physiology of Aging,   7      Intracellular Responses,   13      Chronic Use of Medications,   18      Pharmacoeconomics,   22      Clinical Trial Recruitment,   24      Information Dissemination,   28      Investigators,   29      Summary of the Workshop,   31  3   CONCLUSIONS AND FUTURE RESEARCH DIRECTIONS   35      Research Needs and Opportunities,   35      Summary,   41     APPENDIX: Workshop Agenda, Speakers, and Participants   43

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Pharmacokinetics and Drug Interactions in the Elderly and Special Issues in Elderly African-American Populations: Workshop Summary This page in the original is blank.