Psychopharmacotherapy and adverse drug effects in old age psychiatry

The number of drug prescriptions is continuously increasing with age. Physiologic age-associated pharmacodynamic and pharmacokinetic changes influence drug metabolism and tolerability. Therefore, we analysed the pattern of adverse drug effects, that has been reported to AGATE. Since 1992/1995 AGATE spontaneously monitors adverse drug effects (ADE) and treatment regimen, respectively, in psychiatric state hospitals in Germany. Our analysis comprised >8000 drug prescriptions with >200 ADE-reports (~2,7%) of patients older than 65 years, that have been treated with psychopharmaca. The qualitative composition of the ADE-reports revealed no age-associated differences. However, statistical analysis revealed, that delirium, red blood cell count, peripheral anticholinergic side effects, elevated liver enzymes and extra-pyramidal motor signs were significantly more frequently reported in elderly patients as compared to patients <65 years of age. We conclude, that despite the use of rather low doses in psychopharmacological treatment regimen in old age psychiatry, there is still a high risk for the occurrence of ADE.