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Insomnia drugs for elderly increase auto accident risk.

Benzodiazepines, sold under more than 30 brand names, are among the most frequently prescribed medications in the elderly. Used to treat anxiety and insomnia, their adverse effects include drowsiness, sedation, confusion, and impaired motor function.

A Canadian study, reported in the July 2 issue of the Journal of the American Medical Association, found a significantly increased risk of auto accidents among drivers over 65 years of age who take these medications. The risk was limited, however, to the use of those benzodiazepines that are not quickly eliminated from the body (those with a so-called long half-life). The use of short half-life benzodiazepines (in which half of the drug is eliminated within 24 hours of being taken) was not associated with this risk.

The study found that the risk of auto accident was almost 50 percent higher during the first week when using a long half-life benzodiazepine, decreasing only slightly with prolonged use. The significance of this study is reflected in the statistics for our aging population: the elderly are the fastest-growing segment of the population and compose many of our licensed drivers.

Other studies have shown the crash rate for elderly drivers, after adjusting for the number of miles driven, is twice as high as that for middle-age drivers, and is exceeded only by the under-25 age group. Alcohol is not a major risk factor for motor vehicle crashes among elderly drivers, as it is for younger drivers. The frequency and amount of alcohol use decrease with age, as does the decision to drive after using alcohol.

Benzodiazepine use is but one of the many factors that may impair driving and that are more common among older, as opposed to younger, drivers. These include other medications acting on the central nervous system, neurological disorders, musculoskeletal problems, and other medical conditions. However, because benzodiazepine use is so common among the elderly, it is imperative that persons taking the long half-life drugs observe the manufacturers' warning, clearly printed on the package inserts, against driving while using the drug.

Among the more commonly used long half-life benzodiazepine drugs are: clonazepam (Klonopin), diazepam (T-Quil, Valium, Valrelease, Vazepam, Zetran), clorazepate (Gen-XENE, Tranxene-SD, Tranxene T-Tab), chlordiazepoxide (Librium, Libritabs, Lipoxide), and flurazepam (Dalmane). If taking a drug prescribed for anxiety or insomnia not listed here, check with your pharmacist to determine if the drug is a long half-life benzodiazepine.

On September 11 and 12, the Food and Drug Administration (FDA) will convene a hearing to gather evidence on possible ways to distinguish the abuse potential 6f different benzodiazepines. These and related drugs are among the most widely prescribed pharmaceuticals in the United States for persons of all ages and are used extensively to relieve anxiety, and as sedatives, muscle relaxants, and sleeping pills. Because of these drugs' capacity to produce physical and psychological dependence, the FDA is concerned about their misuse and what is needed to prevent abuse.
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Author:Brown, Edwin W.
Publication:Medical Update
Date:Sep 1, 1997
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