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Laxatives are frequently taken especially by older persons, who have multiple diseases and are disabled. Major differences exist among countries in the type of laxatives taken, and knowledge of the intake patterns is important because of the potential adverse effects associated with particular ingredients. Laxatives and factors related to their use are described in a sample of 3257 patients admitted to 58 hospitals of the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA) in 1991. The mean age was 68.2 years, median 73 years, more than 30% were age > or = 80 years, and 48.7% were men. The overall prevalence rates of laxative use during hospital stay and prior to admission were 11.5% and 11.3%, respectively. Increasing age was independently associated with laxative use after adjusting for gender, activities of daily living, cognitive function, number of active medical problems, medications taken, Italian region and length of stay. After excluding the prescriptions for hyperammoniemia, lactulose was the most frequently taken laxative (prevalence: 6.7% during hospital stay and 4.3% prior to hospital admission), followed by anthranoid laxatives such as senna, cascara, rhein and aloe (1.9% in-hospital and 3.3% pre-hospital). Other less frequently taken laxatives were picosulfate, phenolphthalein, lactitol, glycerol, bisacodyl and docusate. These patterns differ substantially from those reported by surveys conducted in other countries. Further studies are needed to assess the risks and benefits related to the intake of specific laxative ingredients.

The therapeutic management of elderly patients should be extremely careful, particularly in those over 75 years of age. As a matter of fact, in such patients a steep increase of the risk of comorbidity and of dependence has been evidenced. This implies a more complex therapeutic management, that must be oriented to the amelioration of quality of life more than to the resolution of the single pathologies. However, all the intervention trials so far conducted excluded such patients. Therefore, they cannot be considered representative of the geriatric epidemiological reality. As a result, there is virtually no useful information on the efficacy and safety of cardiovascular drugs in patients over 75 years of age. However, the following items should be pointed out: only drugs whose efficacy has been proved should be used, and only after a thorough diagnosis; a multidimensional evaluation should be performed, also addressing psychological, social, environmental and economical factors that could affect the clinical course; the risks and benefits of any therapy should be considered, particularly in the presence of comorbidity, as the number of assumed drugs directly correlates with the risk of developing adverse reactions; drugs should be dosed according to renal function and body weight, possibly starting with half the dosage of younger patients; after starting the therapy, patients should be kept under strict clinical control, and every new symptom should be considered an adverse reaction, unless it will not disappear after withdrawal of the drug; serum drug concentration should be monitored whenever possible, given its larger variability in advanced age.

The effects of L-propionylcarnitine on reperfusion-induced ventricular arrhythmias were studied in isolated hearts from spontaneously hypertensive rats. During reperfusion, 60% (n = 15) of the hearts from control spontaneously hypertensive rats hearts developed irreversible ventricular fibrillation. In contrast, irreversible ventricular fibrillation did not occur in hearts from normotensive Wistar Kyoto rats (n = 11, p less than 0.01). In a second group of spontaneously hypertensive rats, the addition of 10(-6) M L-propionylcarnitine to the medium during ischemia and reperfusion reduced the incidence of irreversible ventricular fibrillation to 14% (n = 14, p less than 0.05 versus control spontaneously hypertensive rats, NS versus Wistar Kyoto rats). Concentrations of L-propionylcarnitine from 10(-6) to 10(-2) M were tested on isolated guinea pig papillary muscles using microelectrodes. Resting potential, action potential amplitude, action potential duration and active tension were not modified by L-propionylcarnitine; and 10(-3) M L-propionylcarnitine did not influence the oscillatory afterpotentials induced by digitalis. We conclude that reperfusion ventricular arrhythmias are more severe in spontaneously hypertensive rats than in Wistar Kyoto rats and that the antiarrhythmic effect of L-propionylcarnitine in spontaneously hypertensive rats is mediated by myocardial protection from damage induced by reperfusion.