nitrazepam and flunitrazepam accounting for 90% of benzodiazepine implicated suicides, in the elderly over a period of 2 decades. In three quarters of cases death was due to drowning, typically in the bath. Benzodiazepines were the predominant drug class in suicides in this review of Swedish death certificates. In 72% of the cases benzodiazepines were the only drug consumed. Benzodiazepines and in particular nitrazepam and flunitrazepam should therefore be prescribed with caution in the elderly. In a brain sample of a fatal nitrazepam poisoning high concentrations of nitrazepam and its metabolite were found in the brain of the deceased person. In a retrospective study of deaths in Sweden, when benzodiazepines were implicated in the deaths, the benzodiazepines nitrazepam and flunitrazepam were the most common benzodiazepines involved. Benzodiazepines were a factor in all deaths related to drug addiction in this study of causes of deaths. In Sweden, nitrazepam and flunitrazepam were significantly more commonly implicated in suicide related deaths than natural deaths. In four of the cases benzodiazepines alone were the only cause of death. In Australia, nitrazepam and temazepam were the benzodiazepines most commonly detected in overdose drug related deaths. In a third of cases benzodiazepines were the sole cause of death. Individuals with chronic illnesses are much more vulnerable to lethal overdose with nitrazepam, as fatal overdoses can occur at relatively low doses in these individuals. Synthesis Reaction of 2-amino-5-nitrobenzophenone (1) with bromoacetyl bromide forms the amide 2. Ring closure in liquid ammonia affords nitrazepam (3). More simply, diazepinone (4) can be nitrated directly at the more reactive C7 position with potassium nitrate in sulfuric acid. See also Benzodiazepine Benzodiazepine dependence Benzodiazepine withdrawal syndrome Long-term effects of benzodiazepines Nimetazepam — methylamino derivative of nitrazepam Flunitrazepam — fluorinated methylamino derivative Clonazepam — chlorinated derivative Fulgazepam - light-activated derivative of benzodiazepine based on photoisomerizable fulgimide References External links Patient information sheet 1 Patient information sheet 2 RxMed - Nitrazepam Inchem - Nitrazepam GABAA receptor positive allosteric modulators Lactams Nitrobenzodiazepines