Relationship between Diazepam Dose, Plasma Level, Age, and Central Nervous System Depression

Reidenberg, M. M.; Levy, Micha; Warner, Howard; Coutinho, Claudia; Schwartz, Morton A.; Yu, Guoquiang; Cheripko, Joyce A.

doi:10.1097/00132586-197904000-00012

Cited by 134 publications

(24 citation statements)

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“…The findings indicate that one factor that may predispose elderly patients to the development of drug‐induced illness is the increased use of drugs. Other investigators have shown that elderly patients are more sensitive to the pharmacologic effects of drugs, probably as a result of decreased ability to metabolize and excrete these compounds (6, 10–12).…”

Section: Discussionmentioning

confidence: 99%

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Drug Use in a Geriatric Population

Hale

Marks

Stewart

1979

J American Geriatrics Society

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Drug usage was studied in a geriatric hypertension-screening program. A questionnaire was used to collect the required information from patients visiting the clinic during three successive years. The study included 1,711 patients, of whom 76.6 percent were regularly using a drug preparation. A consistent increase was noted in the average number of drug categories used with increasing age, from 1.6 in patients under 70 to 2.6 in patients over 84 years old. The most common drug categories involved were antihypertensive agents, cardiovascular drugs, vitamins, and internal analgesics.

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Section: Discussionmentioning

confidence: 99%

“…The incidence of adverse drug reactions as a cause of admission to hospitals has ranged from 2 to 6 percent (4). The elderly are at greater risk for drug‐induced illness than are younger patients (5, 6). It has not been determined whether this increased risk results from increased use of drugs or from increased sensitivity to them.…”

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confidence: 99%

Drug Use in a Geriatric Population

Hale

Marks

Stewart

1979

J American Geriatrics Society

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“…There are several reasons why older patients are particularly at risk for adverse drug reactions. An increase in the sensitivity to many commonly prescribed medications, notably the benzodiazepines, has been noted with increasing patient age 48,49 . Important pathways of drug metabolism in the liver may be impaired in advanced age 50 .…”

Section: Adverse Drug Reactions: Risks and Consequencesmentioning

confidence: 99%

Improving Medication Prescribing and Utilization in the Nursing Home

Gurwitz

Soumerai

Avorn

1990

J American Geriatrics Society

140

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There is ample and compelling evidence to suggest that medications are frequently used inappropriately in the nursing home. The occurrence of avoidable adverse drug reactions is the most serious consequence of inappropriate prescribing; economic implications are also of interest. With increasing concern over the quality of care in nursing homes, and with the revision of regulations governing such care by the Health Care Financing Administration, it is important to consider the experience thus far in monitoring and improving drug use in nursing homes. A number of studies have investigated approaches designed to reduce inappropriate prescribing and drug utilization in this setting. In contrast to the wide range of approaches that have been evaluated and implemented in the hospital setting, interventions in the nursing home have centered primarily around consultant-pharmacist activities. Although these activities are now federally mandated in all nursing homes, there is little evidence from adequately controlled studies to document their impact or cost-effectiveness. By contrast, face-to-face educational interventions directed at physicians ("academic detailing") have been shown to be effective in improving prescribing for some medications. The prominent role played by the nursing staff in the utilization of many medications in the nursing home implies that an educational intervention excluding nursing staff would be insufficient to influence drug utilization positively in many situations (eg, psychoactive medications and laxatives). Future research efforts must pay greater attention to adequate study design considerations as well as to the clinical outcomes of such interventions and their cost-effectiveness.

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“…In addition, a number of papers on severe and in some cases lethal poisonings with the newer and more potent BZD derivatives, such as flunitrazepam [15, 16] and triazolam [17, 18], have recently been published. There is considerable interindividual variability in the response to BZDs [19]. It is therefore difficult to predict the clinical course in each individual case of BZD overdosage.…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14‐year period

Höjer

Baehrendtz

Gustafsson

1989

Journal of Internal Medicine

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A retrospective study covering a 14-year period was carried out to estimate the incidence and assess the clinical features of benzodiazepine (BZD) poisoning. The annual contribution of BZDs to the total number of drug overdose cases admitted to an intensive care unit displayed an increasing trend over the period, and during the last years BZDs were involved in nearly one-third of all cases. Among the 702 cases of BZD overdosage, 144 had ingested BZD alone, 200 had poisoned themselves with BZD combined with alcohol and 358 had taken BZD with other miscellaneous drugs. In 56% of all the cases the patients had severe central nervous system depression on admission. In 47% orotracheal intubation was performed and in 18% artificial ventilation was administered. Complications were recorded in 69 of the 702 cases (9.8%) and five cases were fatal. These clinical features were essentially the same in the group that had overdosed with just BZD. In conclusion, patients with drug overdosage involving BZD have a low hospital mortality, but the acute somatic risk is not negligible. Moreover, they consume a substantial proportion of the resources in the emergency room and the intensive care unit.

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Relationship between Diazepam Dose, Plasma Level, Age, and Central Nervous System Depression

Cited by 134 publications

References 0 publications

Drug Use in a Geriatric Population

Drug Use in a Geriatric Population

Improving Medication Prescribing and Utilization in the Nursing Home

Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14‐year period

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