Midazolam, a short-acting benzodiazepine, is widely used to alleviate patient anxiety, enhance compliance, and aid in anesthesia. While its side effects are typically dose-dependent and manageable with vigilant perioperative monitoring, serious cardiorespiratory complications, including fatalities and permanent neurological impairment, have been documented. Prolonged exposure to benzodiazepines, such as midazolam, has been associated with neurological changes in infants. Despite attempts to employ therapeutic drug monitoring for optimal sedation dosing, its efficacy has been limited. Consequently, efforts are underway to identify alternative predictive markers to guide individualized dosing and mitigate adverse effects. Understanding these factors is crucial for determining midazolam’s suitability for future administration, particularly after a severe adverse reaction. This article aims to elucidate the factors influencing midazolam’s pharmacokinetics and pharmacodynamics, potentially leading to adverse events. Finally, a case study is presented to exemplify the complex investigation into the causative factors of midazolam-related adverse events.

Objectives: While the risks of antipsychotics in older adults are well recognized, clinical trials often exclude frail older patients, have short follow‐up periods, and provide limited comparative data on specific drugs. This study aimed to explore age‐related differences in the adverse effects of six commonly prescribed antipsychotics using a pharmacovigilance database, with additional analysis of sex‐based variations.Methods: We analyzed adverse event (AE) reports associated with aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and haloperidol from the FDA Adverse Event Reporting System (FAERS) database between Q4 2003 and Q2 2024. We utilized Standardized MedDRA Queries (SMQs) and self‐defined queries to categorize 18 groups of AEs. Adjusted logistic regression was employed to calculate adjusted reporting odds ratios (aRORs) with 95% confidence intervals (CIs).Results: Our analysis revealed substance‐specific differences in AE profiles. Risperidone had the highest aROR for hyperprolactinemia (aROR 212, 95% CI 203–221), haloperidol for dystonia (aROR 46, 95% CI 41–51), and aripiprazole for akathisia (aROR 45, 95% CI 42–49). Patients aged 65 and older generally demonstrated a higher likelihood of experiencing cardiac, extrapyramidal motor, and sedative AEs compared to those under 65, with few exceptions across the drugs investigated. In contrast, younger patients showed higher odds for metabolic AEs, including dyslipidemia and hyperglycemia (associated with olanzapine and quetiapine), as well as weight gain (with olanzapine, quetiapine, risperidone, and haloperidol). With few exceptions, women generally showed higher reporting odds of adverse events. Sex‐related differences were especially pronounced for hyperprolactinemia, with 4.7–8.0 times higher reporting odds in women for aripiprazole, olanzapine, quetiapine, and haloperidol—except for risperidone, where a post‐2014 rise in male reports led to higher odds in men. Risperidone was also associated with increased reporting odds of weight gain in men. Additionally, aripiprazole and olanzapine showed 3 to 6 times higher reporting odds for anticholinergic syndrome in men compared to women.Conclusions: It is essential to consider both age and sex in treatment decisions to optimize the efficacy and tolerability of antipsychotic therapy.

Most studies on antipsychotic efficacy and safety, including sex differences, focus on young schizophrenia patients. However, with an aging population, the number of older schizophrenia patients is increasing. This group faces challenges due to varying treatment responses and higher risks of adverse reactions, and guidelines often lack specific recommendations due to insufficient trials. Therefore, we investigated how age and sex influence antipsychotic prescribing practices in schizophrenia using the German Pharmacoepidemiological Research Database (GePaRD). We included patients diagnosed with schizophrenia (ICD-10 code F20.X) who had been prescribed at least one antipsychotic on an outpatient basis in at least two consecutive quarters in 2020, analyzing prescription data for 49,681 patients. Key findings include a notable preference for second-generation antipsychotics (SGAs) across all age groups, especially in younger patients, possibly due to their perceived better tolerability and efficacy. Treatment intensity with SGAs (expressed as the defined daily doses of SGAs per patient in 2020) initially increased with age, peaked among 35- to 44-year-olds, and then decreased, with the lowest treatment intensity in patients aged 65 years and older. The prescription patterns of specific SGAs and first-generation antipsychotics varied across age groups, highlighting the complexity of treatment decisions in schizophrenia management. Sex differences in prescription frequency and treatment intensity were also observed. The basic recommendation of the guideline to consider sex and age when prescribing antipsychotics therefore appears to be followed. Whether this prescribing practice is really optimal for older male and female schizophrenia patients, however, still needs to be proven in clinical trials.

Purpose: Prophylactic antibiotics are used in dental implants to reduce infection risk and implant failure, especially benefiting patients with risk factors. However, evidence suggests that using clindamycin or extending antibiotics postoperatively has an unfavorable risk–benefit ratio. Methods: This national cross-sectional study analyzed antibiotic prophylaxis during implant insertion across Germany. Dentists from the German Society for Oral Implantology (DGOI) provided demographic information and data on the next 10 consecutive implant patients, including age, sex, risk factors, type of implantation, and antibiotic details. Results: 103 dentists participated, providing data on 1040 patients. Most dentists were male and aged 30–64. Patients were evenly split between genders, with an average age of 51 years. Antibiotics were administered in 87.6% of all cases, more frequently for patients undergoing bone augmentation (OR 7.01, p < 0.0001), immediate (OR 3.11, p = 0.002) or delayed (OR 5.30, p < 0.0001) implant insertion, and those with cardiovascular disease (OR 3.24, p = 0.009). 74.8% of implantologists tended to use antibiotic prophylaxis routinely, while the remaining implantologists decided on a case-by-case basis. Implantologists primarily used aminopenicillins for 63.8% of prescriptions and clindamycin for the remaining 35.6%. Additionally, 78.8% of patients with prophylaxis received postoperative, multi-day treatments. Conclusions: The study reveals extensive antibiotic use for perioperative prophylaxis in implant surgery, often not justified by current recommendations, particularly concerning the choice of antibiotic (e.g., clindamycin) and duration (e.g., postoperative use). Specialized clinical guidelines and targeted training for dentists on antibiotic prophylaxis are needed. Graphical