1: Lancet. 2007 Jul 14;370(9582):185-91. The challenge of managing drug interactions in elderly people. Mallet L, Spinewine A, Huang A. Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada. Drug therapy is essential when caring for elderly patients, but clearly it is a double-edged sword. Elderly patients are at high risk of having drug interactions, but the prevalence of these interactions is not well documented. Several types of interactions exist: drug-drug, drug-disease, drug-food, drug-alcohol, drug-herbal products, and drug-nutritional status. Factors such as age-related changes in pharmacokinetics and pharmacodynamics, frailty, interindividual variability, reduced homoeostatic mechanisms, and psychosocial issues need to be considered when drug interactions are assessed. Software can help clinicians to detect drug interactions, but many programmes have not been updated with the evolving knowledge of these interactions, and do not take into consideration important factors needed to optimise drug treatment in elderly patients. Any generated recommendations have to be tempered by a holistic, geriatric, multiprofessional approach that is team-based. This second paper in a series of two on prescribing in elderly people proposes an approach to categorise drug interactions, along with strategies to assist in their detection, management, and prevention. PMID: 17630042 [PubMed - indexed for MEDLINE] Related Links Prescribing in older people. [Aust Fam Physician. 2004] PMID:15532150 Drug interactions in the elderly. How multiple drug use increases risk exponentially. [Postgrad Med. 1989] PMID:2685792 Principles of drug therapy in geriatric patients. [Am Fam Physician. 1992] PMID:1595518 Medication use in the elderly patient: focus on the perioperative/perianesthesia setting. [J Perianesth Nurs. 2004] PMID:15801351 Drug interactions in the older patient. [Geriatrics. 1988] PMID:3192083