Related Clinical Concerns
Children
BZs have been known to have a paradoxical effect on children contributing to personality changes and irritability. The use of any kind of sedatives in sleep disturbances is not well investigated in controlled studies in children.
Adolescents
Anxiolytics may interfere with common teen activities including school, driving and sports contributing to safety and compliance issues.
Older Adults
The best choices for antianxiety medications in elderly persons are short-acting, low-potency agents without active metabolites, such as oxazepam. The minimum effective dose is 50% of the usual adult dose. This should be given as needed only for 1 to 2 weeks. Paradoxical reactions from BZs are more common in the elderly contributing to agitation rather than the desired effect.
The association of fetal damage with BZs is controversial (Barki, Kravitz, & Barkin, 1998). However, it is recommended that BZs be tapered off sufficiently before delivery to minimize neonatal and infant withdrawal. Lorazepam (Ativan) and oxazepam have less potential for accumulation in neonates. BZs at relatively low doses are not contraindicated in nursing mothers (Rubey & Lydiard, 1999).