Which benzodiazepines are considered safe for the elderly and those with liver impairment?

• A. Diazepam, Clonazepam
• B. Flurazepam, Temazepam
• C. Lorazepam, Oxazepam
• D. Alprazolam, Chlordiazepoxide

Answer: (C)

Lorazepam and oxazepam are considered safe options for the elderly and patients with liver impairment due to their pharmacokinetic profiles. Unlike many other benzodiazepines, lorazepam and oxazepam are both conjugated rather than extensively metabolized by the liver, which is significant since elderly patients often have reduced liver function. This leads to a lower risk of accumulation and related side effects.

In practice, elderly patients are particularly sensitive to the effects of benzodiazepines, which can lead to increased sedation, confusion, and a higher risk of falls. Lorazepam and oxazepam can be initiated at lower doses, and their safety profiles allow for more predictable outcomes. Additionally, these agents have a lower potential for drug interactions due to their minimal hepatic metabolism, further supporting their use in populations with liver impairment.