>1 The use of hypnotics in the elderly must be approached with special care in view of possible changes in pharmacokinetic behaviour and drug interactions in older patients.>2 In a randomized, double-blind study in a large geriatric department, midazolam was compared with the barbiturate combination Vesparax with regard to efficacy and safety.>3 The comparison of the efficacy of the 2 hypnotics showed them to be almost identical in this respect. Side-effects, however, were more frequent with Vesparax. Furthermore, in the Vesparax group, unlike in the midazolam group, a troublesome cumulation of effect was observed, together with relatively frequent signs of hangover.>4 It is concluded that, in appropriately titrated dosage, midazolam is an effective and well-tolerated hypnotic for use in the elderly.
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