Which benzodiazepine is preferred in elderly patients requiring anxiolysis because it does not undergo hepatic Phase I oxidative metabolism and has no active metabolites?
- A Diazepam
- B Chlordiazepoxide
- C Oxazepam ✓
- D Nitrazepam
Correct answer: C. Oxazepam
Explanation
Oxazepam (along with lorazepam and temazepam — mnemonic LOT) undergoes only Phase II glucuronide conjugation, bypassing hepatic CYP-mediated oxidation; this pathway is minimally affected by age-related hepatic decline, producing predictable pharmacokinetics without accumulation. Diazepam, chlordiazepoxide and nitrazepam undergo Phase I oxidation producing long-acting active metabolites (e.g., desmethyldiazepam), which accumulate in elderly patients causing prolonged sedation and falls.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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