Long-acting and short-acting benzodiazepines in the elderly: kinetic differences and clinical relevance

A review of available information about the pharmacokinetics of pro-nor-diazepam-like compounds in the elderly shows substantial impairment of the metabolism compared to oxazepam-like benzodiazepines, which are metabolized with virtually no change in this age group. Results of clinical trials point in the same direction, although small numbers of patients, different criteria for measuring clinical benefit and adverse reactions and different dosages for various periods of time make the comparison difficult. Qualified clinical guidelines are mainly to reduce dosage and use oxazepam-like compounds in the elderly, but routine clinical practice does not seem to apply these recommendations. Further research is therefore needed, mainly in the area of clinical practice, to describe the 'real' situation of benzodiazepine prescription for in-patients and out-patients in terms of risk-benefit ratio of drug treatment and to monitor the changes occurring when a more rational approach is introduced as regards the need for treatment, dose and duration of treatment.