Polypharmacy and adverse drug reactions in the aging population with heart failure

Normal aging is associated with numerous alterations in body composition and organ function that result in substantial changes in the absorption, distribution, metabolism, and elimination of virtually all drugs. In addition, older patients with heart failure almost invariably have multiple coexisting medical conditions for which they are receiving medications. Taken together, these factors greatly increase the risk for adverse drug events and drug interactions in older heart failure patients. This chapter reviews common adverse drug effects and drug interactions associated with heart failure therapy in older patients and discusses strategies for minimizing the risk of adverse drug events. In addition, the intersection between heart failure medications and common geriatric syndromes, including polypharmacy, falls and syncope, and fatigue and low energy, is briefly reviewed.