PHARMACOTHERAPY REVIEW CNS STIMULANTS for treatment of ...

In Table 2 of the Beer’s List (Attachment A), which addresses suggestions formedications to avoid in elderly patients with specific concomitant diseases, the sedativehypnoticsas a class are listed as drugs that represent high risk in patients with chronicobstructive pulmonary disease The Beer’s List does not recognize nonbenzodiazepinesas a safer or more appropriate sedative-hypnotic than benzodiazepines regardless ofduration of action, active metabolites v. no active metabolites and so forth.In Table 2 of the Beer’s List (Attachment A), the long-acting benzodiazepines aresuggested as medications to avoid in elderly patients with vascular disorders thatpredispose them to syncope and falls. The benzodiazepine GABA agonists, temazepamand triazolam, are not long-acting benzodiazepines. Temazepam is intermediate in itsduration of action and triazolam is short-acting. The Beers List does not address ordifferentiate risk between temazepam, triazolam or zolpidem in elderly patients withvascular disorders.RECOMMENDATIONThe previous sedative-hypnotic review, review of available clinical studies, andassessment of the updated Beer’s List (1997) does not present clinical evidence sufficientto support the recommendation of any brand name nonbenzodiazepine or benzodiazepineGABA agonist over multisource triazolam or temazepam on grounds of greater efficacy,safety or tolerability. Specifically, the nonbenzodiazepine GABA agonists, zaleplon andzolpidem, show no significant clinical advantage over multisource triazolam ortemazepam relative to efficacy, safety and tolerability.No brand name sedative-hypnotic agents are recommended to the P&T Committee forpreferred drug status.