From the Guidelines
Cefpodoxime can cause side effects in elderly patients with dementia, and due to the high risk of polypharmacy and adverse events in this population, its use should be carefully considered and monitored. Elderly patients with dementia are at increased risk of adverse effects due to age-related changes in drug metabolism, reduced kidney function, and potential drug interactions with medications commonly prescribed for dementia 1. Common side effects of cefpodoxime include diarrhea, nausea, and abdominal discomfort, which may occur in up to 10% of patients. Additionally, there is a small risk of Clostridioides difficile-associated diarrhea, which can be more severe in older adults.
Key Considerations
- Elderly patients with dementia may be more susceptible to certain adverse effects due to age-related changes in drug metabolism and reduced kidney function 1.
- Potential drug interactions with cholinesterase inhibitors or other medications commonly used in dementia treatment should be considered 1.
- A systematic, comprehensive review of medications is encouraged for all individuals with dementia and frailty, and deprescribing unnecessary or inappropriate medication as per published criteria is recommended 1.
Recommendations
- Dosage adjustments may be necessary based on kidney function, and close monitoring for adverse effects is important.
- Healthcare providers should consider using established criteria such as the STOPP/START or Beers criteria to assess potentially inappropriate medications 1.
- Educating individuals with dementia about their medications is crucial 1.
From the FDA Drug Label
Of the 3338 patients in multiple-dose clinical studies of cefpodoxime proxetil film-coated tablets, 521 (16%) were 65 and over, while 214 (6%) were 75 and over. No overall differences in effectiveness or safety were observed between the elderly and younger patients. Nervous – dizziness, insomnia, somnolence, anxiety, shakiness, nervousness, cerebral infarction, change in dreams, impaired concentration, confusion, nightmares, paresthesia, vertigo
Cefpodoxime Side Effects in Elderly with Dementia: The FDA drug label does not provide specific information about the side effects of cefpodoxime in elderly patients with dementia. However, it does mention that no overall differences in effectiveness or safety were observed between the elderly and younger patients in multiple-dose clinical studies.
- The label reports the following nervous system-related side effects:
- Dizziness
- Insomnia
- Somnolence
- Anxiety
- Shakiness
- Nervousness
- Cerebral infarction
- Change in dreams
- Impaired concentration
- Confusion
- Nightmares
- Paresthesia
- Vertigo It is essential to note that these side effects are not specifically attributed to elderly patients with dementia, but rather to the elderly population in general. 2
From the Research
Cefpodoxime Side Effects in Elderly Patients with Dementia
- There is limited research directly addressing the side effects of cefpodoxime in elderly patients with dementia.
- A study from 1990 3 evaluated the pharmacokinetics of cefpodoxime in young adult and elderly patients, but it did not specifically focus on patients with dementia.
- Another study from 2003 4 discussed the pharmacokinetics and therapeutic uses of cefpodoxime, mentioning its safety and low incidence of side effects, but did not address the elderly population with dementia.
- A 2017 review 5 on cefepime-induced neurotoxicity may provide some indirect insights, as it discussed the potential for cephalosporins to cause neurotoxicity, especially in patients with renal dysfunction or those who are overdosed. However, this study focused on cefepime, not cefpodoxime.
- A 2024 systematic review 6 on the clinical pharmacokinetics of cefpodoxime provided comprehensive information on its pharmacokinetics but did not specifically address side effects in elderly patients with dementia.
- A 2007 review 7 on adverse events associated with oral cephalosporins/cephems mentioned typical adverse events such as nausea, vomiting, diarrhea, and hypersensitivity reactions but did not focus on the elderly population with dementia.