Which benzodiazepines are more suitable for elderly patients or those with liver issues?

The choice of Lorazepam, Oxazepam, and Temazepam as the most suitable benzodiazepines for elderly patients or those with liver issues is primarily based on their pharmacokinetic profiles. These medications are preferred because they are metabolized differently compared to other benzodiazepines.

Lorazepam and Oxazepam are primarily glucuronidated, which means they do not undergo extensive metabolism in the liver's cytochrome P450 system. This makes them safer options for individuals with liver impairment, as they are less likely to accumulate and cause adverse effects. Temazepam also follows a similar metabolic pathway, making it suitable for elderly patients who may have decreased liver function or are on multiple medications, reducing the risk of drug interactions.

In contrast, other benzodiazepines listed in the alternatives often have active metabolites and are extensively metabolized by the liver, making them less suitable for the elderly or those with liver issues, as they can lead to increased sedation, confusion, and risk of falls. Therefore, LOT is the optimal choice for safely managing anxiety or sleep disturbances in these populations.