Adverse effects of single therapeutic doses of diazepam on performance in normal geriatric subjects: Relationship to plasma concentrations

Pomara, Nunzio; Stanley, Bárbara; Block, Robert I.; Guido, Julia; Russ, Dor; Berchou, Richard; Stanley, Michael; Greenblatt, David J.; Newton, Roger E.; Gershon, Samuel

doi:10.1007/bf00555210

Cited by 46 publications

(19 citation statements)

References 28 publications

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“…The single-dose effects of diazepam (2.5, 5, and 10 mg) on memory functioning and psychomotor performance were examined in 12 healthy elderly (mean age 70 years) 1 and 3 hours after administration [67]. All dosages of diazepam significantly impaired performance on the tests.…”

Section: Diazepammentioning

confidence: 99%

Effects of Sleep Medications on Cognition, Psychomotor Skills, Memory and Driving Performance in the Elderly

Verster¹,

Volkerts²,

Spence

et al. 2007

CPSR

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Sleep disturbances occur more often in the elderly than in patients in any other age category. Traditional treatment regimens for insomnia in older patients have emphasized benzodiazepines. The useful anxiolytic and hypnotic properties of these agents have made them the most widely prescribed class of drugs in the world. Concern has been expressed however about the significant side effect profile associated with these agents. There is now considerable evidence that all benzodiazepines show significant dose-dependent impaired daytime performance on a variety of memory, cognitive and psychomotor tests. In addition, the risk of falls, hip fractures, and traffic accidents is significantly increased in patients who are treated with benzodiazepines. There is little evidence that benzodiazepine hypnotics are still effective after chronic use. On the other hand, several impairments persist when using these hypnotics over long time. Recently, the nonbenzodiazepine drugs zolpidem and zaleplon have been introduced and are claimed to be relatively safe (i.e. less daytime sedation) when compared to benzodiazepines. Zopiclone, a non-benzodiazepine hypnotic, shows no advantages over benzodiazepines with respect to daytime performance.Several factors may interact with the effects of hypnotics on daytime functioning, including normal cognitive decline during aging, the effects of insomnia itself on daytime functioning, the presence or absence of co-morbid disorders, and pharmacokinetic changes accompanying aging. The impact of hypnotics on daytime performance further depends on various drug-related factors including the administered dose, half-life, time between intake and performance, duration of treatment, gender, and individual differences.In contrast, zolpidem and zaleplon do not significantly impair daytime performance when administered at bedtime at the recommended dose. Although further studies of drug effects in elderly insomniacs are necessary, the available evidence suggests that these short acting and relatively safer non-benzodiazepine hypnotics are a preferred alternative therapy for treating insomnia in the elderly.

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Section: Diazepammentioning

confidence: 99%

Effects of Sleep Medications on Cognition, Psychomotor Skills, Memory and Driving Performance in the Elderly

Verster¹,

Volkerts²,

Spence

et al. 2007

CPSR

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“…They are known to cause dependence and withdrawal syndromes, impair cognition, and increase the risk of falls and hip fractures in the elderly (2)(3)(4)(5)(6)(7). Despite these problems, few studies have assessed the extent of their use among hospitalized elderly patients.…”

mentioning

confidence: 99%

Benzodiazepine Utilization in a University Hospital

et al. 1994

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Benzodiazepines are widely prescribed in the hospital setting in the absence of appropriate documentation. Older patients are as likely to receive benzodiazepines as younger patients, despite the known morbidity associated with their use in this population. Differences in prescribing practices by race, the longer length of stay among patients receiving benzodiazepines, and the appropriate use of benzodiazepines in the elderly require further study.

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“…In the context of therapeutic trials, several controlled clinical studies suggest that reduced doses of various benzodiazepine hypnotics (flurazepam, triazolam, brotizolam, nitrazepam) are sufficient to produce clinically acceptable hypnotic efficacy in elderly patients (Frost & DeLucchi 1979;Roehrs 1985;Viukari et al 1984). Some studies assessing adverse effects or intensity of pharmacodynamic actions of benzodiazepines in the elderly either do not concurrently study young control subjects or do not assess plasma drug concentrations (Hinrichs & Ghoneim 1987;Nikaido et al 1987Nikaido et al , 1990Pomara et al 1984;Satzger et al 1990), thereby not addressing the question of true 'biological' sensitivity. Although access to the target organ uptake and neuroreceptor phenomena involved in the pharmacological cascade (fig.…”

mentioning

confidence: 99%

Clinical Pharmacokinetics of Anxiolytics and Hypnotics in the Elderly

Greenblatt

Harmatz

Shader

1991

Clinical Pharmacokinetics

127

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Part I of this article, which appeared in the previous issue of the Journal, discussed the scope of and scientific basis for special pharmacokinetic studies of anxiolytic and hypnotic drugs in the elderly, and examined the methodology and results of such studies and the prediction of pharmacokinetic changes. In Part II the authors continue their review, focusing on age-related pharmacodynamic changes in the effects of these drugs, the attempts to correlate pharmacokinetic with pharmacodynamic findings, and the clinical applications of these data.

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Adverse effects of single therapeutic doses of diazepam on performance in normal geriatric subjects: Relationship to plasma concentrations

Cited by 46 publications

References 28 publications

Effects of Sleep Medications on Cognition, Psychomotor Skills, Memory and Driving Performance in the Elderly

Effects of Sleep Medications on Cognition, Psychomotor Skills, Memory and Driving Performance in the Elderly

Benzodiazepine Utilization in a University Hospital

Clinical Pharmacokinetics of Anxiolytics and Hypnotics in the Elderly

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