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Letters |

Benzodiazepine Use and Crash Risk in Older Patients

Nunzio Pomara, MD; Hla Tun, MD; Daniel DaSilva, PhD; Dennis Deptula, PhD; Nathan S. Kline; David J. Greenblatt, MD
JAMA. 1998;279(2):113-115. doi:10.1001/jama.279.2.113.
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To the Editor.—Dr Ray's1 Editorial that accompanies the article by Dr Hemmelgarn and colleagues2suggests that the common use of many of the short-elimination half-life benzodiazepines as hypnotics in the elderly may account for the lack of an association between these drugs and risk of injurious motor vehicle crashes. After bedtime administration, peak plasma-drug concentrations would occur at night. Thus, sleeping patients avoid the drug-associated cognitive and psychomotor impairments. Rapid drug elimination would result in minimal next-day effects. Ray1cautioned that daytime use of these drugs as anxiolytics, as with longer half-life drugs, would result in peak pharmacological actions during the day and possible increased risk of injurious motor vehicle crashes. Hemmelgarn et al2 did not indicate whether benzodiazepines with relatively short half-life were preferentially used as hypnotics rather than anxiolytics. Thus, lack of observed association between these drugs and driving-crash risk remains unexplained. Although next-day impairment associated with long half-life benzodiazepines such as diazepam is well established,3few studies have examined shorter half-life drugs.

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Changes from baseline for the standardized mean-of-all-tests (Buschke Selective Reminding Test Total Recall, Delayed Recall, and Intrusion Errors; Discriminant Reaction Time; Critical Flicker Fusion) for the 5 parallel treatment groups. A shows the effects of acute single doses at initial challenge; B, the next-day effects after 1, 2, and 3 weeks of long-term, twice-daily treatment; C, the effects of acute single doses at rechallenge after 3 weeks of long-term, twice-daily treatment. Asterisk indicates P<.05; dagger, P<.001; and double dagger, P<.01, for comparison of drug vs placebo.

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