Chlordiazepoxide (Librium®), diazepam (Valium®) and flurazepam (Dalmane®) are long-acting benzodiazepines.
They are metabolized by oxidative pathways in the liver to active metabolites.
The elderly often experience a decline in the ability to metabolize drugs by oxidative routes, and drug accumulation is extensive.
The elderly are also more sensitive to the effects of benzodiazepines. Long-acting benzodiazepines have been associated with falling.
These drugs should be avoided in the elderly whenever possible.
If a benzodiazepine is necessary, shorter acting agents such as lorazepam (Ativan) or oxazepam (Serax) would be preferred because they are not eliminated by oxidative pathways.1
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- Avoid long-acting benzodiazepines whenever possible.
- Use shorter acting lorazepam or oxazepam if a benzodiazepine is necessary.
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