Temazepam

Indications

Temazepam is used for: Insomnia, Premedication in surgery

Adult Dose

Oral Short-term management of insomnia Adult: 7.5-30 mg at bedtime for 7-10 days. Max: 40 mg. Elderly: 5 mg at bedtime. May be increased to 10-20 mg in severe cases. Hepatic impairment: 5 mg at bedtime. May be increased to 10-20 mg in severe cases. Severe: Contraindicated. Premedication in surgery Adult: 20-40 mg, 30 min to 1 hr before the procedure. Elderly: 10-20 mg, 1 hr before the procedure. Hepatic impairment: Severe: Contraindicated.

Child Dose

Safety and efficacy not established

Renal Dose

Insomnia Renal impairment: 5 mg at bedtime. May be increased to 10-20 mg in severe cases.

Administration

May be taken with or without food. Gradually taper after extended therapy; abrupt discontinuation should be avoided

Contra Indications

Acute pulmonary insufficiency, resp depression, sleep apnoea, obsessional states, myasthenia gravis, severe hepatic impairment. Pregnancy.

Precautions

Patient w/ severe depression, chronic pulmonary insufficiency, personality disorders, history of alcohol or drug addiction. Avoid abrupt withdrawal. Renal and hepatic impairment. Elderly or debilitated patient. Lactation. Patient Counselling May impair ability to perform tasks that require alertness (e.g. driving or operating machinery). Monitoring Parameters Monitor resp and CV status. Lactation: Avoid if breastfeeding

Pregnancy-Lactation

Pregnancy Category: X Lactation: Avoid if breastfeeding Minor tranquilizers should be avoided in 1st trimester of pregnancy due to increased risk of congenital malformations Maternal use shortly before delivery is associated with floppy infant syndrome (good and consistent evidence) Prenatal benzodiazepine exposure slightly increased oral cleft risk (limited or inconsistent evidence)

Interactions

May enhance CNS depressant effect w/ Na oxybate, antipsychotics, tranquilisers, neuroleptics, antidepressants, hypnotics, anaesth, analgesics, sedative antihistamines, barbiturates. Effect may be reduced w/ theophylline.

Adverse Effects

Side effects of Temazepam : 1-10% Drowsiness (9.1%), Dizziness (4.5%), Lethargy (4.5%), Hangover (2.5%), Diarrhea (1.7%), Euphoria (1.5%), Weakness (1.4%), Confusion (1.3%), Vertigo (1.2%) < 1% Amnesia, Angioedema, Blood dyscrasias, Sleep-related behavior (eg, sleep driving, sleep cooking, sleep eating), Ataxia

Mechanism of Action

Temazepam is a short-acting benzodiazepine w/ anxiolytic, hypnotic/sedative, muscle relaxant properties. It increases neuronal membrane permeability to Cl ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron w/in the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilisation.