Medications are one of the most difficult aspects of care for older adults. The geriatric population experiences polypharmacy, increased risk for adverse drug events, and altered pharmacokinetics/pharmacodynamics. Pharmacokinetic changes include slowed oral absorption, reduced volume of distribution for hydrophilic medications, increased volume of distribution for lipophilic drugs, reduced metabolism, and reduced excretion. Older adults often have pharmacodynamic changes with increased sensitivity for drugs with a site of action in the central nervous system. Pharmacogenomic information may provide guidance to personalize medication choice and dose to avoid adverse drug events. Polypharmacy contributes to increased risk for adverse drug events by increasing drug exposure. A close review of a patient’s medications before prescribing a new agent helps identify unnecessary drugs and prescribing cascades.