Avoiding Drug-Induced Hypoglycemia in the Older Adult

Mary Ann E. Zagaria, PharmD, MS, BCGP


US Pharmacist. 2019;44(10):4-10. 

In This Article

Advancing Age: Polypharmacy, Nonadherence, Unintended Weight Loss

Older adult patients often have multiple medications, multiple comorbidities, and multiple prescribers.[8] Polypharmacy associated with clinical practice guidelines for older adults, an individual patient's self-management through the use of OTC medications, herbal products, and supplements can complicate the regimen of an older adult and need to be thoroughly considered, evaluated, and modified as appropriate.[7]

There should be special geriatric consideration regarding a decision to initiate certain drugs (i.e., particularly those agents in which coadministration with insulin may induce severe hypoglycemia [e.g., pramlintide]) in the older- adult population; such a decision should be carefully based on several factors, including the patient's functional status and how well the patient recognizes hypoglycemic and hyperglycemic symptoms and how to respond to them.[9]

Additionally, as mentioned above, symptom manifestation and a subjective reduction in quality of life that a patient attributes to medication therapy (e.g., adverse drug effects, troublesome administration, tedious and uncomfortable monitoring) can also contribute to medication nonadherence. In an older adult, addressing deficits in vision and hearing, swallowing and motor impairment, cognition, and health literacy can lead to enhanced medication adherence.[8] It should also not be overlooked in the elderly that unintended weight loss (e.g., secondary to malignancy) may be an insidious precipitator of hypoglycemia.