Prescribing in Older People

Abstract The pharmacokinetics and pharmacodynamics of most drugs are altered to an important extent in older people. These changes in drug handling and action must be taken into account if treatment is to be effective and adverse effects minimised. Oral anticholinergic agents used for hypersalivation (e.g. hyoscine hydrobromide) should be avoided in older people because of the risk of cognitive impairment, delirium and constipation. While some studies have found that antidepressant use in older people may be associated with an increased risk of dementia, it is important to keep in mind that previous studies have shown that late‐life depression is associated with an increased risk for dementia. Network meta‐analysis suggests that quetiapine, duloxetine, agomelatine, imipramine and vortioxetine have the highest efficacy in major depressive disorder in older people, although individual data are somewhat inconsistent.