flurazepam hydrochloride

flu·raz·e·pam hydrochloride (fl-rz-pm)

n.

A benzodiazepine drug, usually used to treat insomnia.

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flurazepam hydrochloride

[floo͡raz′əpam]

a benzodiazepine sedative-hypnotic agent.

indication It is prescribed in the short-term treatment of insomnia.

contraindications Liver or kidney insufficiency, sleep apnea, and known hypersensitivity to this drug prohibits its use.

adverse effects Among the most serious adverse effects are possible physical and psychologic dependence. Dizziness and drug hangover may also occur, and there have been instances of anterograde amnesia with aggressive behavior.

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flurazepam hydrochloride

Apo-Flurazepam (CA), Dalmane, Novo-Flupam (CA), Somnol (CA)

Pharmacologic class: Benzodiazepine

Therapeutic class: Sedative-hypnotic

Controlled substance IV

Pregnancy risk category X

Action

Depresses CNS at limbic, thalamic, and hypothalamic levels by enhancing inhibitory neurotransmitter effect of gamma-aminobutyric acid on neuronal excitability

Availability

Capsules: 15 mg, 30 mg

⊘Indications and dosages

➣ Short-term management of insomnia (less than 4 weeks)

Adults: 15 to 30 mg P.O. at bedtime

Dosage adjustment

• Elderly or debilitated patients

Contraindications

• Hypersensitivity to drug or other benzodiazepines
• Preexisting CNS depression
• Angle-closure glaucoma
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• hepatic dysfunction
• history of suicide attempt or drug dependence
• elderly patients
• children younger than age 15 (safety not established).

Administration

• Before starting therapy, evaluate patient's mental status and check kidney and liver function tests and CBC.

Route	Onset	Peak	Duration
P.O.	15-45 min	0.5-1 hr	7-8 hr

Adverse reactions

CNS: dizziness, daytime drowsiness, headache, lethargy, confusion, poor concentration, depression, paradoxical excitation, ataxia

EENT: blurred vision

GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain

Respiratory: sleep apnea

Skin: rash

Other: abnormal taste, hangover, physical or psychological drug dependence, drug tolerance

Interactions

Drug-drug. Antidepressants, antihistamines, opioids: additive CNS depression

Barbiturates, rifampin: increased flurazepam metabolism, decreased efficacy

Cimetidine, disulfiram, fluoxetine, hormonal contraceptives, isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, valproic acid: decreased flurazepam metabolism, enhanced efficacy

Levodopa: decreased levodopa efficacy

Theophylline: decreased sedative effects of flurazepam

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, total and direct bilirubin: increased levels

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: additive CNS depression

Drug-behaviors. Alcohol use: additive CNS depression

Smoking: increased drug metabolism and clearance

Patient monitoring

• With long-term use, watch for signs and symptoms of physical or psychological dependence.
• Monitor patient's mental status, especially for depression and suicidal ideation.
• Watch for signs of drug hoarding or overuse.
• Monitor CBC and liver and kidney function tests.

Patient teaching

☞ Urge patient (and significant other as appropriate) to report signs and symptoms of depression or suicidal thoughts or actions.
☞ Advise female patient to immediately tell prescriber if she is pregnant. Caution her not to breastfeed.
• Inform patient that drug may cause physical or psychological dependence.
• Advise patient to minimize GI upset by eating frequent, small servings of food and drinking adequate fluids.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.