Appropriate prescribing in the elderly: Current perspectives

Table 5 Commonly used drugs - comparison of prescription between older and younger patients

Drug	Typical dose in younger patient (< 65 yr)	Typical dose in older patient (≥65 yr)	Reason for different dose in the elderly
Anti-arrhythmics
Digoxin	Loading dose is 1-1.5 mg in divided doses over 24 h Maintenance dose 125-250 mcg OD	Loading dose is 1 mg in divided doses over 24 h Maintenance dose 62.5-125 mcg OD	Water soluble contributing to increased plasma levels in the elderly
Anti-coagulants
Warfarin	Standard initiation dose, e.g., 10 mg daily for two days	Lower initiation dose, e.g., 5 mg daily for two days	Increased sensitivity to anticoagulant effect
Dabigatran	150 mg BD	Patient > 80 yr 110 mg BD Patient 75-80 yr 150 mg BD in setting or normal eGFR	Increased sensitivity to anticoagulant effect
Anti-hypertensive
Ramipril	Initiation dose 2.5 mg	Initiation dose 1.25 mg	Lower initial dose and gradual dose titration required (higher risk of ADE in the elderly)
Psychoactive drugs
Diazepam	2 mg TDS	1 mg BD	Lipid soluble with higher volume of distribution in older people thus contributing to a prolonged duration of effect

OD: Once daily; BD: Twice daily; TDS: Three time daily.