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Titolo:
RATIONAL USE OF BENZODIAZEPINES IN THE ELDERLY
Autore:
SHORR RI; ROBIN DW;
Indirizzi:
VANDERBILT UNIV,MED CTR,SCH MED,DEPT PREVENT MED NASHVILLE TN 37232 VANDERBILT UNIV,MED CTR,SCH MED,DEPT MED NASHVILLE TN 37232
Titolo Testata:
Drugs & aging
fascicolo: 1, volume: 4, anno: 1994,
pagine: 9 - 20
SICI:
1170-229X(1994)4:1<9:RUOBIT>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
PSYCHOTROPIC-DRUG USE; RAPIDLY ELIMINATED BENZODIAZEPINES; UPPER GASTROINTESTINAL ENDOSCOPY; TERM THERAPEUTIC USE; INCREASED SENSITIVITY; HIP FRACTURE; TRIAZOLAM SYNDROME; CIGARETTE-SMOKING; REBOUND INSOMNIA; HYPNOTIC DRUGS;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
105
Recensione:
Indirizzi per estratti:
Citazione:
R.I. Shorr e D.W. Robin, "RATIONAL USE OF BENZODIAZEPINES IN THE ELDERLY", Drugs & aging, 4(1), 1994, pp. 9-20

Abstract

In the 40 years since the introduction of benzodiazepines into clinical practice, considerable controversy has surrounded their use. While there is little evidence to suggest widespread abuse or long term use in most age groups, benzodiazepines continue to be widely prescribed to older adults in both community and long term care settings. Several studies have described an increased sensitivity to the clinical effects and toxicity of benzodiazepines in older adults. However, it is unclear whether these observations are attributable to age-related changesin benzodiazepine pharmacokinetics or pharmacodynamics. Benzodiazepines are the safest and most effective agents available for the pharmacological management of symptoms of anxiety and insomnia. However, the acute administration of benzodiazepines is associated with impairments in cognition, memory, coordination and balance, and long term use, even at therapeutic dosages, has been associated with symptoms of withdrawal upon abrupt discontinuation. Therefore, it is essential that the practitioner develop a treatment plan when utilising these agents to treat older patients. This plan may also involve the implementation of psychotherapy or other nonpharmacological modalities in the management of anxiety or insomnia. Although we recommend initiating benzodiazepines using the lowest available dosage, older patients should be treatedwith enough drug to produce a therapeutic response. For most clinicalsituations of anxiety or insomnia, we recommend prescribing limited quantities (e.g. a 2-week supply with a return visit for re-evaluation of effectiveness and adverse effects) of a drug with a short elimination half-life. Persistent anxiety or insomnia in the elderly may require a medical and possibly psychiatric evaluation. If benzodiazepines are used continuously for 6 weeks or longer, we recommend a gradual taper over 2 to 12 weeks with frequent follow up to evaluate for signs or withdrawal or the return of symptoms.

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Documento generato il 10/07/20 alle ore 18:08:13