Use of Sedatives and Psychotropic Drugs in Elderly Patients: A Case Report

Abstract

Introduction: The use of sedatives in frail older adults represents a significant challenge in clinical and nursing practice due to age-related pharmacokinetic and pharmacodynamic changes that increase susceptibility to adverse drug reactions. Physiological alterations such as reduced hepatic metabolism, decreased renal clearance, altered protein binding, and increased blood-brain barrier permeability enhance drug accumulation and central nervous system sensitivity. Benzodiazepines and antihistamines with anticholinergic properties are widely recognized as potentially inappropriate medications in this population and are associated with an increased risk of delirium, hypotension, respiratory depression, falls, and cardiac arrhythmias, particularly in patients with cardiovascular and renal comorbidities.

Results: A 73-year-old institutionalized female patient with diabetes mellitus, systemic arterial hypertension, acute renal failure, and congestive heart failure developed severe psychomotor agitation during a night shift. She received intravenous diazepam 2 mg and intramuscular promethazine 12.5 mg for agitation control. Within two hours, she progressed to marked hypotension, respiratory depression, and hemodynamic instability, requiring flumazenil administration, intravenous fluid resuscitation, and norepinephrine infusion. Despite ventilatory support and continuous cardiac monitoring, the patient experienced two episodes of cardiac arrest due to ventricular fibrillation and underwent advanced cardiopulmonary resuscitation without return of spontaneous circulation.

Conclusion: This case underscores the importance of cautious prescribing, comprehensive risk benefit assessment, strict monitoring, and prioritization of non-pharmacological strategies when managing agitation and delirium in frail older adults.

Citation

Souza JM. Use of Sedatives and Psychotropic Drugs in Elderly Patients: A Case Report. WebLog J Clin Case Rep. wjccr.2026.c2701. https://doi.org/10.5281/zenodo.19316826