The United States Census Bureau estimates that by the year 2030, the proportion of the population over 65 years of age in the United States is expected to rise to 2064 with the greatest surge among the oldold over 85 years of age. Increases in medication utilization are anticipated since older people account for more than 30 of total drug expendituresincluding prescription and over-the-counter drugs.42,47 Eighty percent of older Americans have more than one chronic illness42 and are on multiple medications often prescribed by different health care providers. The major challenges facing health care providers caring for older patients are to minimize polypharmacy, adverse drug reactions, and drugdrug interactions that are more likely to occur because of the use of multiple medications, comorbidities, and age-related changes in the pharmacokinetics and pharmacodynamics of drugs. Adverse drug reactions in the older individual are the cause of an estimated 10 to 25 of hospital admissions.34,42 The older person is predisposed to adverse drug reactions and interactions because of age-related changes in major organs that affect the pharmacokinetics and pharmacodynamics of drugs. Two basic areas of pharmacology describe the relationship between the dose of drug given to an older individual to the ability of that drug to treat the patient's disease. Pharmacokinetics is the way in which the body manipulates drugs and pharmacodynamics is the mechanism of action and physiological effect of drugs in the body. An example of these two principles is the following: an 80-year-old woman complains of lightheadedness and drowsiness (adverse reactions) but relief of pain (pharmacodynamics) after taking ibuprofen 800 mg which she takes for chronic arthritic pain. A serum creatinine is checked and the level has increased from 0.7mg/dL baseline to 1.0mg/dL (pharmacokinetics). In this article, pharmacokinetic and pharmacodynamic changes in the elderly are presented with available supporting literature and with a focus on medications commonly prescribed for rheumatic diseases.

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