When prescribing drug therapy for an older adult, which type of drug should be avoided, if possible?

Drugs with a long half-life should be avoided in older adults whenever possible because this population often has altered pharmacokinetics, meaning the way the body absorbs, distributes, metabolizes, and excretes medications can differ significantly from younger adults.

Specifically, older adults may have diminished liver and kidney function, which affects the metabolism and clearance of drugs. A long half-life indicates that the drug remains in the body for an extended period before it is eliminated. This can lead to an accumulation of the drug and increase the risk of adverse effects, drug toxicity, and potential interactions with other medications. Given that many older patients are often on multiple prescriptions, the risk of complications rises when dealing with medications that linger in the system.

In contrast, low protein-binding drugs, liquid formulations, and topical application drugs can generally be managed more safely within the older population, although they too have their considerations. Low protein-binding drugs may be preferred in some cases despite their potential risks, and liquid formulations can be easier for older adults to ingest, especially if they have swallowing difficulties. Topical medications typically minimize systemic absorption and can be beneficial for localized treatment, thus representing a generally safer option compared to drugs with longer systemic effects.