Benzodiazepine poisoning in elderly

Abstract

Background/Aim. Benzodiazepines are among the most frequently ingested drugs in self-poisonings. Elderly may be at greater risk compared with younger individuals due to impaired metabolism and increased sensitivity to benzodiazepines. The aim of this study was to assess toxicity of benzodiazepines in elderly attempted suicide. Methods. A retrospective study of consecutive presentations to hospital after self-poisoning with benzodiazepines was done. Collected data consisted of patient's characteristics (age, gender), benzodiazepine ingested with its blood concentrations at admission, clinical findings including vital signs and Glasgow coma score, routine blood chemistry, complications of poisoning, details of management, length of hospital stay and outcome. According the age, patients are classified as young (15-40-year old), middle aged (41-65-year old) and elderly (older than 65). Results. During a 2-year observational period 387 patients were admitted because of pure benzodiazepine poisoning. The most frequently ingested drug was bromazepam, the second was diazepam. The incidence of coma was significantly higher, and the length of hospital stay significantly longer in elderly. Respiratory failure and aspiration pneumonia occurred more frequently in old age. Also, flumazenil was more frequently required in the group of elderly patients. Conclusion. Massive benzodiazepines overdose in elderly may be associated with a significant morbidity, including deep coma with aspiration pneumonia, respiratory failure, and even death. Flumazenil is indicated more often to reduce CNS depression and prevent complications of prolonged unconsciousness, but supportive treatment and proper airway management of comatose patients is the mainstay of the treatment of acute benzodiazepine poisoning.

Effect of aromatherapy massage on anxiety, depression, and physiologic parameters in older patients with the acute coronary syndrome: A randomized clinical trial

“…Currently, more attention is paid to complementary and alternative medicine (CAM) strategies, because they have fewer complications and are easy to access (Mohammadpour et al, 2014). These strategies are highly recommended in older patients with an impaired metabolism and increased sensitivity to the side effects of drugs (Perković-Vukčević, Vuković-Ercegović, Šegrt, Đorđević, & Jović-Stošić, 2016). For instance, cognitive and cardiovascular adverse effects among older people, after the use of tranquillisers and cardiovascular drugs, are very common (Sztramko, Chau, & Wong, 2011).…”

Polydrug epidemiology: Benzodiazepine prescribing and the drug overdose epidemic in the United States

“…Benzodiazepines potentiate the respiratory effects of opioids and are associated with aberrant drug‐taking behaviors . Elderly patients are at heightened risk of adverse incidence of overdose and other injuries (such as fractures and falls) from both opioids and benzodiazepines . Substantial nonmedical use of prescription drugs, especially opioids and sedatives, has been documented among elderly Americans, most worryingly with suicidal intent …”

“…Robustness tests not shown here confirm that these results are substantively unchanged through other model specifications, such as ordi- from both opioids and benzodiazepines. [30][31][32] Substantial nonmedical use of prescription drugs, especially opioids and sedatives, has been documented among elderly Americans, most worryingly with suicidal intent. 33,34 While these results pile on to the substantial clinical literature documenting the harmful interaction between these classes of drugs, they also reveal an ecological risk to high levels of benzodiazepine prescriptions, especially alongside elevated rates of opioid prescriptions, that has not yet been documented in the literature.…”

Evaluation of factors related to overdose in patients with impaired consciousness who are transported by emergency medical services: an age-specific research

“…In addition, significant increases in the prevalence of BZ exposure and overdose have been observed, especially in children [13]. In other reports, acute BZ intoxication and accidental overdose have been reported in elderly people [14][15][16]. Furthermore, some studies have reported that antidepressants are more commonly used for intentional drug overdose in women than in men [17][18][19].…”