THE EFFECT OF AGE ON PHARMACOKINETICS OF ANTIEPILEPTIC DRUGS

Management of epilepsy in the elderly requires understanding of the un ique biochemical and pharmacologic characteristics of this patient pop ulation. Accurate assessment of seizures and identification of epileps y syndromes, thorough neurologic assessment to define etiology, and co mprehensive evaluation of the patient's health and living situation ar e necessary for informed management decisions. Challenges to treatment include concomitant diseases, polypharmacy with accompanying drug int eractions, and changes in physiology, such as changes in renal clearan ce and hepatic function that alter drug absorption, protein binding, m etabolism, and elimination. Elderly patients with declining intellectu al function, motor impairment, or altered sensory function may be espe cially susceptible to dose-related CNS side effects of antiepileptic d rugs (AEDs). Drugs prescribed for concomitant illnesses such as hypert ension, cardiovascular disease, infections, behavioral problems, and g astrointestinal disturbances may alter absorption, distribution, and m etabolism of AEDs, with an adverse impact on efficacy and increased oc currence of adverse effects. The AEDs may induce metabolism of other d rugs, resulting in decline in target response, Addition of an AED to a n elderly patient's medical regimen requires careful review of all pre scribed drugs, Optimal care of elderly patients with epilepsy includes use of free drug Levels to monitor AED concentrations, careful dose s election, and sensitivity to the social problems that may occur in thi s population.