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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]
Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, alcohol- or drug-dependent individuals, and individuals with comorbid psychiatric disorders. [4] As with many other drugs, changes in liver function associated with aging or diseases such as cirrhosis, may lead to impaired clearance of nordazepam. [5]
Benzodiazepines are also sometimes taken intra-nasally when not recommended for use this way by their prescriber. [83] In the elderly, alcohol and benzodiazepines are the most commonly used addictive substances, and the elderly population is more susceptible to benzodiazepine withdrawal syndrome and delirium than are younger patients. [84]
Special precaution is required when using clorazepate in the elderly because the elderly metabolise clorazepate more slowly, which may result in excessive drug accumulation. Additionally the elderly are more sensitive to the adverse effects of benzodiazepines compared to younger individuals even when blood plasma levels are the same.
The protracted withdrawal syndrome from benzodiazepines, opioids, alcohol and other addictive substances can produce symptoms identical to generalized anxiety disorder as well as panic disorder. Due to the sometimes prolonged nature and severity of benzodiazepine, opioid and alcohol withdrawal, abrupt cessation is not advised. [13]
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]
Prazepam is a benzodiazepine derivative drug developed by Warner-Lambert in the 1960s. [2] It possesses anxiolytic , anticonvulsant , sedative and skeletal muscle relaxant properties. [ 3 ] Prazepam is a prodrug for desmethyldiazepam which is responsible for the therapeutic effects of prazepam.
Benzodiazepine withdrawal syndrome (BZD withdrawal) is the cluster of signs and symptoms that may emerge when a person who has been taking benzodiazepines as prescribed develops a physical dependence on them and then reduces the dose or stops taking them without a safe taper schedule.
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