use of benzodiazepines in the aged patient: clinical and pharmacological considerations

Benzodiazepines are widely used to treat anxiety and insomnia in elderly patients. The interest of this prescription is discussed in this article. The discussion is based on the pharmacological properties and adverse effects of benzodiazepines in the elderly subjects. The conclusions are that benzodiazepines should be rarely prescribed in elderly people; many patients treated by benzodiazepines should be withdrawn and other therapeutic strategies than benzodiazepines should be considered to treat anxiety and insomnia in the elderly patients

Clinical pharmacokinetics of benzodiazepines

The present article summarizes the clinical pharmacokinetic properties of benzodiazepines. The goal is to better prescribe these compounds in the field of anxiety, sleep disorders and as anticonvulsive drugs. All pharmacokinetic parameters are overviewed: absorption, blood protein binding distribution, metabolisation and half-lives. A new approach is tried to find relationship between brain concentrations and receptor bindings in the purpose of giving an explanation of their duration of effect

Strategy for prescribing hypnotics

The present article identifies the appropriate strategies for the prescription of hypnotic drugs. Initially, a clinical evaluation of insomnia is provided which includes definitions of good and poor sleepers and the physiology of sleep. The article then proceeds to discuss drugs commonly used in the treatment of sleep disorders such as, barbiturates, benzodiazepines and other, newer compounds. The pharmacokinetic properties of these compounds are briefly described, as are effects of age. The review concludes with suggestions for the proper identification of patients requiring chemical treatment for sleep disorders, and highlights methodologies for choosing the most beneficial pharmacological tools