Penentuan

Dosis Obat
pada Geriatri
dan Pasien
Gangguan
Ginjal
Andri Tilaqza, M.Farm., Apt
 Perubahan Pada Geriatri

Fisiologis

Geriatri
Absorbsi

Distribusi
Farmako- Farmako-
Metabolisme kinetika dinamik

Ekskresi
 Ekskresi
– Ginjal merupakan organ utama dalam hal ekskresi
obat
– Fungsi ginjal menurun pada geriatric shg
mempengaruhi ekskresi obat
– t ½ (waktu paruh obat) ↑
– durasi obat ↑
– efek obat ↑
– resiko terjadinya efek samping ↑
– resiko konsentrasi meningkat diatas MTC  hati-
hati pada obat dg indeks terapi (therapeutic
windows) yang sempit
 Ekskresi

– Dosis harus disesuaikan dengan bersihan ginjal/clearance creatinine (rumus

Cockcroft)

– Satuannya adalah mL/menit (Untuk pasien wanita dikalikan dg 0,85)

– Bisa juga menggunakan rumus MDRD (modification of diet in renal disease)
Nilai Clearance Creatinin
Normal
Allopurinol
Contoh kasus

– Hitunglah penyesuaian dosis Allopurinol yang akan diberikan

kepada seorang pasien wanita dengan data sebagai berikut
– Usia 65 tahun,
– berat badan 50 kg
– tinggi badan 159 cm
– kadar ureum darah 90 mg/dL
– kadar kreatinin darah 2.5 mg/dL
Captopril

– Dosing: Elderly Refer to adult dosing

– Clcr 10-50 mL/minute: Administer 75% of normal dose.

– Clcr <10 mL/minute: Administer 50% of normal dose
Chlorpropamide

Adult dose
– Initial dose: 250 mg/day in mild-to-moderate diabetes in middle-aged, stable diabetic;
100-125 mg/day in older patients
– Titration: Subsequent dosages may be increased or decreased by 50-125 mg/day at 3-
to 5-day intervals
– Maintenance dose: 100-250 mg/day; severe patients with diabetes may require 500
mg/day; avoid doses >750 mg/day

Dosing: Elderly
• Reduce initial dose to 100-125 mg/day in older patients; subsequent
dosages may be increased or decreased by 50-125 mg/day at 3- to 5-day
intervals (slower upward titration may be appropriate in older patients)
• Clcr <50 mL/minute: Avoid use.
Bisoprolol

Hypertension: Oral: 2.5-5 mg once daily; may be increased to 10 mg and

then up to 20 mg once daily, if necessary; usual dose range (JNC 7): 2.5-10
mg once daily
HF (unlabeled use): Initial: 1.25 mg once daily; maximum recommended
dose: 10 mg once daily. Note: Increase dose gradually and monitor for signs
and symptoms of CHF.
Dosing: Elderly
Oral: Initial: 2.5 mg/day; may be increased by 2.5-5 mg/day; maximum
recommended dose: 20 mg/day
Dosing: Renal Impairment
Amlodipin

– Hypertension: Oral: Initial dose: 5 mg once daily; maximum dose: 10 mg once daily.
In general, titrate in 2.5 mg increments over 7-14 days. Usual dosage range (JNC 7):
2.5-10 mg once daily.
– Dosing: Elderly Dosing should start at the lower end of dosing range due to possible
increased incidence of hepatic, renal, or cardiac impairment. Elderly patients also
show decreased clearance of amlodipine.
– Geriatric Considerations Elderly may experience a greater hypotensive response.
Constipation may be more of a problem in elderly. Calcium channel blockers are no
more effective in elderly than other therapies, however, they do not cause
significant CNS effects which is an advantage over some antihypertensive agents.
Hypertension: Oral: 2.5 mg once daily
Ciprofloxacin

– Oral: 500 mg every 12 hours

– Geriatric Considerations Elderly may experience a greater hypotensive response. Constipation
may be more of a problem in elderly. Calcium channel blockers are no more effective in
elderly than other therapies, however, they do not cause significant CNS effects which is an
advantage over some antihypertensive agents.
– Dosing: Renal Impairment Adults:
– Clcr 30-50 mL/minute: Oral: Administer 250-500 mg every 12 hours.
– Clcr <30 mL/minute: Acute uncomplicated pyelonephritis or complicated UTI: Oral: Extended release
formulation: 500 mg every 24 hours
– Clcr 5-29 mL/minute:
– Oral: Administer 250-500 mg every 18 hours.
– I.V.: Administer 200-400 mg every 18-24 hours.
Loading Dose
dan
Maintenance
Dose
 Istilah istilah yang harus
dipahami
– Loading dose/initial dose/dosis awal/dosis muatan
– Maintenance dose/dosis pemeliharaan
– Stady state/konsentrasi tunak
– MEC (Minimum Effective Concentration)
– MTC (Minimum Toxic Concentration)
– Therapeutic Window/Indek terapi
Kurva Profil Farmakokinetika
Oral
 Bolus IV
Kurva Profil
Farmakokinetika

Infus
Per Oral
Theophylline

– Loading dose:
– ADULTS & CHILDREN: PO 5 mg/kg.

– Maintenance dose:
– CHILDREN 9–16 YR & YOUNG ADULT SMOKERS: PO 3 mg/kg q 6 hr.
– CHILDREN 1–9 YR: PO 4 mg/kg q 6 hr.
– ELDERLY & COR PULMONALE PATIENTS: PO 2 mg/kg q 8 hr.
– PATIENTS WITH CHF: PO 1–2 mg/kg q 12 hr.
– NONSMOKING ADULTS: PO 3 mg/kg q 8 hr.
Clopidogrel

– Recent MI, Recent Stroke, or Established Peripheral Arterial Disease:

– PO 75 mg once daily with or without food.
– Acute Coronary Syndrome (Unstable Angina/Non-Q-Wave MI):
– loading dose : PO Start with a 300 mg,
– Maintenance dose : then continue at 75 mg once daily, initiating and
continuing aspirin (75 to 325 mg/day) in combination with clopidogrel.
Common drug interactions in
elderly
 Obat-
obat

Interaksi
obat

Obat - Obat -
makanan herbal
Corticosteroid steroid equivalences
 Manakah yang
diperbolehkan
pada pasien
geriatri?

Bagaimana
cara
Efek
Kortikosteroid menghitung
sampingnya??
equivalensi
dosis nya?

Apakah
diperlukan
tapering off?
Mengapa?
Drugs to be avoided in geriatric age
group
Drugs to be avoided in geriatric age
group