Controlled Comparison of Four Sedative Drugs in Elderly Patients

Exton‐Smith, A. N.; Hodkinson, H. M.; Cromie, B. W.

doi:10.1136/bmj.2.5364.1037

Cited by 15 publications

(9 citation statements)

References 11 publications

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“…Comparison studies have shown barbiturates as effective as benzodiazepines or neuroleptics, but their effectiveness diminishes rapidly with time 63,133 . The high frequency of barbiturate side effects have discouraged their use in the elderly 134,135 . Chloral hydrate usually has been studied as a sedative in the elderly 136–138 .…”

Section: Other Drugsmentioning

confidence: 99%

Pharmacologic Treatment of Agitation Associated With Dementia

Risse

Barnes

1986

J American Geriatrics Society

120

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Pharmacotherapy of aggressive or agitated behaviors in the dementia patient has not been studied extensively, despite the prevalence of this problem. Neuroleptics have the most support for efficacy, with shorter acting benzodiazepines demonstrating benefit on occasion. However, studies done to date indicate that these drugs are effective only for a minority of patients and that side effects frequently make patients worse. Other medications, such as propranolol, carbamazepine, or lithium, may be helpful, but their efficacy in dementia patients has not been demonstrated in placebo-controlled studies. Until such studies are done, their use is most appropriate in special patient groups or in patients who have failed neuroleptic or benzodiazepine treatment. More studies are needed in elderly patients evaluating effectiveness of pharmacologic agents in specific types of dementia, particularly Alzheimer's disease. Most studies done to date have been of relatively short duration, usually two months or less. Because these medications often are given to dementia patients for prolonged periods, studies are needed to define the long-term clinical efficacy of these agents. In the clinical setting, these agents should be reduced periodically or discontinued to determine ongoing need. In addition, environmental, social, or behavioral methods of reducing agitated behaviors need to be explored as an adjunct to any medication trial.

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Section: Other Drugsmentioning

confidence: 99%

Pharmacologic Treatment of Agitation Associated With Dementia

Risse

Barnes

1986

J American Geriatrics Society

120

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“…Some physicians are cautious in their approach to sedation in these organic cases but it is still surprising to note the widespread, overenthusiastic prescription of powerful agents under circumstances where a mild sedative would have the desired effect in calming agitation and improving sleep without producing a morning hangover effect (52, 55–60). Severe unexpected reactions may follow the use of sedatives in the elderly; for example, barbiturates will produce marked and occasionally fatal cerebral depression (40) if given even in conservative dosage to a myxoedematous patient.…”

Section: Diagnosis In Relation To Therapymentioning

confidence: 99%

The Chemopsychotherapeutics of Geriatric Sedation

Dawson-Butterworth

1970

J American Geriatrics Society

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This article indicates some of the social, emotional, organic factors involved in disturbing the balance of the geriatric psychological equilibrium and outlines the need for an appropriate rationale of treatment with modern tranquillisers and sedatives. Both the problem of individual variation to treatment and the need for delineation of contributory organic factors are emphasised. Some features of senile psychoses, delirium, and depression are considered. Reference is made to the principles of sedation and tranquillisation and a number of the more widely used agents are reviewed. Some of the more notable side e1fects are briefly outlined.Several clinical group studies involving the use of sedatives and tranquillisers were made on 143 patients from a generalhospital geriatric unit and 41 geriatric patients from a psychiatric hospital. The presence of mental illness in geriatric patients was not associated with long-term need for nocturnal sedatives but did tend to increase the duration of hospitalisation and reduce the chances of rehabilitation. It was found possible to manage all types of patients in the geriatric range without barbiturates, which are contraindicated. The need for a more flexible approach to medication in the psychiatric geriatric population is indicated. Some of the currently available ehemopsychotherapeutic agents, although useful, are of only limited value in aiding the more disturbed patients.

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“…In the previous study (Exton-Smith et al, 1963) it was demon strated that these four drugs all had hypnotic activity as compared with the placebo when judged by the nurses' hourly check. Mepro bamate and dichloralphenazonc were, however, preferred by the patients to the two other drugs and in the dosage used mepro bamate and dichloralphenazone were considered to be satisfactory hypnotics for use in elderly patients.…”

Section: Smith Et Al 1963mentioning

confidence: 99%

The Use and Abuse of Hypnotics

1967

Geront clin

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Controlled Comparison of Four Sedative Drugs in Elderly Patients

Cited by 15 publications

References 11 publications

Pharmacologic Treatment of Agitation Associated With Dementia

Pharmacologic Treatment of Agitation Associated With Dementia

The Chemopsychotherapeutics of Geriatric Sedation

The Use and Abuse of Hypnotics

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