Monday, January 25, 2010

DDP 2010: Medication Management in the Elderly: Capitalize on Opportunities for Advances in Drug Delivery and Formulation Technologies

Thomas M. Reilly, PhD, MBA
BDHorizons, LLC

Older populations use more drugs, over 2/3 of patients over 65 have chronic diseases. Most patients are taking more than one medicine. Over 125,000 deaths each year are the result of medication mismanagement. Poor compliance also results in poor outcomes and poor quality of life.

Common medication problems in the area
-Dysphagia (Difficulty swallowing)
-Poor drug absorption from the GI
-Xerostomia (dry mouth, often induced by medication)
-Polypharmacy – too many drugs

This is in addition to other common problematic symptoms –
-Diminished sight/hearing
-Impaired stomach/intestinal mobility
-Diminished mental faculties
-Poor cooperation
-Limited mobility

Advantages of Transdermal Delivery. Many companies are focusing on this for geriatrics, so it is an option for consistent drug delivery to the elderly population.
-Exploits large surface area of skin for drug absorption
-Transdermal patches provide controlled continuous delivery of drug, while avoiding problems of first pass metabolism and dysphagia associated with oral dosing
-Ease of use
-Patent acceptability
-Caretaker preference

Parkisnon’s Disease
-Second most common neurodegenerative disease with average age of onset of 60
-PD symptoms often interfere with oral dosing in patients: dysphagia, gastric stasis, drooling, shaking and tremors and dementia. It’s difficult to continue traditional oral therapy here.

Current medications used to treat this: Exceeded $1.5 billion in sales
-Levodopa (converted to dopamine in CNSO
-Dopamine agonists (Requip, Mirapex)
-MAO-B Inhibitors (selegine)

Urinary Incontinence
-Common problem in the elderly affecting up to 35% of the geriatric population
-A leading cause of institutionalized among the elderly
-Huge economic burden on society

Issues with oral medication –
-Associated with high rates of side effects (dry mouth, constipation) which promote poor compliance, especially in the elderly. Compliance in this category are especially low.
-Part of the problem with oral oxybutynin is metabolism to active metabolite (N-DEO) in intestine and liver

Advances in formulations and delivery
-ER formulations of anticholinergics for once-a-day dosing
-Oxytrol ®: Transdermal patch from Watson. It delivers oxybutynin continuously over 3-4 days. Skin irritation has been the main problem. It’s resulted in the creation of a gel.

Age-related macular degeneration (ARMD)
-Leading cause of vision loss and blindness in the elderly
-Affects up to 10 million Americans, with epidemic proportions expected by 2040 due to demographics
-Wet and dry forms
Dry is the most common, it’s really the precursor. No way to prevent this to the conversion of the wet form. It occurs in the back of the eye, so it’s very difficult to deliver blood there. Current treatments require interval injections.

-Addressing medication problems in the elderly offers huge potential for both societal and economic gains.

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