Alprazolam ≥2 mg/day | Warning—dose alert, increased sensitivity in the elderly … more | ‘Because of increased sensitivity to benzodiazepines in elderly patients, smaller doses may be effective as well as safer. Total daily doses should rarely exceed the suggested maximum.’ | Alprazolam <0.75 mg |
Diazepam | Warning—prolonged half-life in the elderly, high fall risk … more | ‘Older benzodiazepines (BZDP) such as diazepam, have a prolonged half-life due to their lipid solubility and the presence of active metabolites. In elderly patients, their half-life may potentially exceed several days, resulting in prolonged sedation and increasing the risk of falls and fractures. Short- and intermediate-acting BZDP are preferred if a benzodiazepine is actually required.’ | Alprazolam 0.125–0.25 mg twice daily; not to exceed 2 mg every day Buspirone 5 mg twice daily, up to 20–30 mg every day; not to exceed 60 mg every day; mg twice daily; not to exceed 2 mg every day Lorazepam:0.5 mg two to three times a day; not to exceed 3 mg/day Oxazepam: 10 mg two to three times a day; not to exceed 60 mg/day
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Cyclobenzaprine (Flexeril, McNeil Consumer and Specialty Pharmaceuticals, Fort Washington, PA) | Warning—high risk of anticholinergic reactions in the elderly … more | ‘Most skeletal muscle relaxants are poorly tolerated by elderly patients. Some drugs, including cyclobenzaprine, may have anticholinergic adverse effects as well as causing sedation and weakness. Agents such as carisoprodol are metabolised to meprobamate which has a significant abuse potential. Additionally, the effectiveness of these drugs at dosages tolerated by elderly patients is questionable. The long-term safety and efficacy of skeletal muscle relaxants for chronic low back pain is unclear and not recommended.’ | |
Hydroxyzine | Warning—high risk of anticholinergic reactions in the elderly … more | ‘Some non-prescription and prescription antihistamines may have potent anticholinergic properties. In addition to traditional anticholinergic symptoms of constipation, urinary retention, and blurred vision, these drugs may cause confusion and delirium, especially if other drugs with anticholinergic properties are present. Non-anticholinergic antihistamines are preferred in elderly patients especially when needing to treat allergies chronically.’ | Loratidine 10 mg every day; 10 mg every other day in renal or hepatic failure Cetirizine 10 mg every day; decrease by 50% in renal or hepatic failure Fexofenadine 60 mg twice daily or 180 mg every day; 60 mg every day in renal failure
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Oxybutynin (regular release) | Warning—high risk of anticholinergic reactions in the elderly … more | ‘Regular release products containing oxybutynin, a urinary antispasmotic agent, may be poorly tolerated by many elderly patients. Anticholinergic effects are common and include confusion and agitation in addition to traditional anticholinergic effects of constipation and tachycardia. Additionally, their effectiveness at doses tolerated by elderly patients is questionable’. | Ditropan XL, Ortho-McNeil Pharmaceuticals, Raritan, NJ Detrol LA, Pfizer, New York, NY Solifenacin, darifenacin, trospium
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