Toxicity of nitrazepam in the elderly: a report from the Boston Collaborative Drug Surveillance Program.

Abstract

1 To assess the potential hazards of nitrazepam therapy of insomnia in the elderly, adverse reactions to nitrazepam were studied in 2111 hospitalized medical patients who received the drug. 2 Manifestations of unwanted central nervous system (CNS) depression (such as drowsiness or 'hangover') were reported in 49 nitrazepam recipients (2.3%), and signs of unwanted CNS stimulation (such as nightmares, insomnia, agitation, etc.) in 15 (0.7%). None of the adverse reactions were considered serious. 3 Physician‐rated clinical efficacy of nitrazepam was not related to dose, but the frequency of both types of adverse reactions increased significantly at higher daily doses. CNS depression also was significantly more frequent in the elderly, being reported in 11% of those aged 80 years or older, whereas the frequency of CNS stimulation was not correlated with age. 4 The effect of age on the reported rate of unwanted CNS depression was most striking at high doses. Among patients aged 80 years or over whose daily dose averaged 10 mg or more, 55% experienced unwanted CNS depression attributed to nitrazepam. 5 Low doses of nitrazepam are safe for elderly individuals, but the elderly are readily susceptible to excessive CNS depression at high doses. The findings suggest that there is little reason to exceed 5mg doses of nitrazepam for most patients, particularly those who are elderly.

Real-world evidence for the safety of ipragliflozin in elderly Japanese patients with type 2 diabetes mellitus (STELLA-ELDER): final results of a post-marketing surveillance study

“…In the present survey, age ≥75 years and concomitant diuretic use were risk factors for volume depletion-related ADRs. The relationship between diuretic use and volume depletion was expected because higher doses of loop diuretics may cause hypovolemia in patients with renal insufficiency [19], and volume depletion is a frequent adverse reaction to diuretics [20,21]. These findings are consistent with those of a pooled analysis of patients treated with 100 mg canagliflozin, 300 mg canagliflozin, or placebo/active comparators [22], where volume depletion-related AEs occurred in 4.9%, 8.7%, and 2.6% of 8949 patients aged ≥75 years, respectively, compared with 2.2%, 3.1%, and 1.4% of 490 patients aged <75 years.…”

Beta-adrenergic receptor blockers. Adverse effects and drug interactions.

“…Adverse reactions were seen more commonly among older patients. 4 In patients with hypertension, the frequency of adverse reactions with atenolol were reported to be approximately 15% in a 4-year follow-up study. 6 In an extensive literature survey in 15,753 patients receiving pindolol, a similar incidence of side effects was seen.…”

“…In some instances, vascular compromise has been severe enough to cause cyanosis and impending gangrene. 4 * This is probably due to the reduction in cardiac output and blockade of /3 2 -adrenergic receptor-mediated skeletal muscle vasodilation, resulting in unopposed a-adrenergic receptor vasoconstriction.…”

Effect of Repeated Gaboxadol Administration on Night Sleep and Next-Day Performance in Healthy Elderly Subjects

“…Moreover, many benzodiazepines have been found to produce residual effects the next morning, including daytime sedation, impaired attention, and memory (Gorenstein and Gentil, 1983;Harrison et al, 1985;Roehrs et al, 1986;Hindmarch and Fairweather, 1994). Elderly people appear more sensitive to the sedative effects of hypnotics than the young (Greenblatt et al, 1977;Greenblatt and Allen, 1978;Monane, 1992). Zopiclone and zolpidem are newer hypnotics that lack the benzodiazepine structure, but still interact with the benzodiazepine receptor.…”