Medication Regimen Adjustments for Elderly Patients

Introduction to Adjusted Medication Regimens

The American Geriatrics Society recommends that elderly patients taking multiple sedating medications, such as lorazepam, hydroxyzine, trazodone, mirtazapina, and buspirona, should have their medication regimen adjusted to prevent falls, cognitive decline, and respiratory depression 1

The use of benzodiazepines, such as lorazepam, in elderly patients increases the risk of falls, cognitive decline, tolerance, and addiction, with a recommended maximum dose of 2 mg/day 2, 3
The duplication of therapeutic agents, such as hydroxyzine and lorazepam, increases the risk of excessive sedation, respiratory depression, and falls 2

The British Medical Journal recommends that benzodiazepines, such as lorazepam, should be avoided in elderly patients due to the risks outweighing the benefits, and that they should be gradually discontinued over 1-2 weeks to avoid withdrawal syndrome 3, 1
The World Journal of Emergency Surgery suggests that hydroxyzine should be gradually discontinued over 1 week due to its potential to cause excessive sedation and somnolence 4

The Mayo Clinic Proceedings recommends that buspirona, at a dose of 30-45 mg/day, is the only appropriate medication as a first-line treatment for anxiety in elderly patients, with a gradual increase in dose to achieve optimal efficacy 1
The World Journal of Emergency Surgery suggests that if buspirona is insufficient, selective serotonin reuptake inhibitors (SSRIs), such as sertralina, can be considered as a first-line treatment for anxiety in elderly patients, with a starting dose of 25 mg/day and gradual increase to 50-100 mg/day 4

The American College of Cardiology recommends that elderly patients undergoing medication regimen adjustments should be monitored weekly for falls, sedation, and cognitive function, as well as orthostatic vital signs to detect hypotension 1, 2
The British Medical Journal suggests that the dosage of all medications should be adjusted according to renal function in elderly patients 1, 4