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In the elderly, long-term benzodiazepine therapy is a risk factor for amplifying cognitive decline, [29] although gradual withdrawal is associated with improved cognitive status. [30] A study of alprazolam found that 8 weeks administration of alprazolam resulted in deficits that were detectable after several weeks but not after 3.5 years. [31]
Nordazepam is a partial agonist at the GABA A receptor, which makes it less potent than other benzodiazepines, particularly in its amnesic and muscle-relaxing effects. [6] Its elimination half life is between 36 and 200 hours, with wide variation among individuals; factors such as age and sex are known to impact it. [2]
Chlordiazepoxide is generally considered an inappropriate benzodiazepine for the elderly due to its long elimination half-life and the risks of accumulation. [10] Benzodiazepines require special precaution if used in the elderly, pregnancy, children, alcohol- or drug-dependent individuals and individuals with comorbid psychiatric disorders. [11]
Symptoms of floppy infant syndrome and the neonatal benzodiazepine withdrawal syndrome have been reported to persist from hours to months after birth. [12] Special precaution is required when using clorazepate in the elderly because the elderly metabolise clorazepate more slowly, which may result in excessive drug accumulation.
Brotizolam [3] (marketed under brand name Lendormin) is a sedative-hypnotic [4] thienotriazolodiazepine [5] drug which is a benzodiazepine analog. [6] It possesses anxiolytic, anticonvulsant, hypnotic, sedative and skeletal muscle relaxant properties, and is considered to be similar in effect to other short-acting hypnotic benzodiazepines such as triazolam or midazolam. [7]
Diazepam, sold under the brand name Valium among others, is a medicine of the benzodiazepine family that acts as an anxiolytic. [14] It is used to treat a range of conditions, including anxiety, seizures, alcohol withdrawal syndrome, muscle spasms, insomnia, and restless legs syndrome. [14]
Failure to treat benzodiazepine dependence in the elderly can cause serious medical complications. [14] The elderly have less cognitive reserve and are more sensitive to the short (e.g., in between dose withdrawal) and protracted withdrawal effects of benzodiazepines, as well as the side-effects both from short-term and long-term use. This can ...
A study of the elderly who were benzodiazepine dependent found withdrawal could be carried out with few complications and could lead to improvements in sleep and cognitive abilities. At 52 weeks after successful withdrawal, a 22% improvement in cognitive status was found, as well as improved social functioning.
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