Benzodiazepines in the elderly and in liver disease

Three benzodiazepines are not metabolized by oxidation mediated by the CYP450 isoenzymes: lorazepam, oxazepam, temazepam (mnemonic: L.O.T.). I have heard clinicians sometimes wrongly say that these three benzodiazepines are “not metabolized in the liver” or that they are “not metabolized.” Neither of these is true. These three are metabolized in the liver but by being direct glucuronidation. By “direct” I…