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April 9, 1982

Prescribing of Benzodiazepines

Author Affiliations

St Louis University Medical Center St Louis

JAMA. 1982;247(14):1936. doi:10.1001/jama.1982.03320390020014

To the Editor.—  The article entitled "Benzodiazepine Prescribing in a Family Medicine Center" by Jeffrey D. Hasday, MD, and Fred E. Karch, MD (1981;246:1321), is helpful in elucidating some of the factors influencing the prescription of benzodiazepines and other minor tranquilizers to patients. I wish to emphasize, however, that the benzodiazepines are a diverse group of compounds. Thus, while it is important to maintain a patient on the lowest dose and a limited daily regimen for a number of reasons, the statement by the authors that it is a "good practice considering the altered pharmacokinetics and pharmacodynamics of benzodiazepines in the elderly" is not necessarily true. This statement is true with respect to chlordiazepoxide and the clinically important metabolite common to diazepam, prazepam and clorazepate, or nordiazepam.1,2 However, oxazepam and lorazepam do not appear to have appreciably altered pharmacokinetics and pharmacodynamics in the elderly.3,4 Therefore, when an antianxiety