temazepam
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temazepam
[tĕ-maz´ĕ-pam]temazepam
Pharmacologic class: Benzodiazepine
Therapeutic class: Sedative-hypnotic
Controlled substance schedule IV
Pregnancy risk category X
Action
Depresses CNS at limbic, thalamic, and hypothalamic levels. Enhances effects of gamma-aminobutyric acid, resulting in sedation, hypnosis, skeletal muscle relaxation, and anticonvulsant and anxiolytic activity.
Availability
Capsules: 7.5 mg, 15 mg, 22.5 mg, 30 mg
Indications and dosages
➣ Insomnia
Adults: 15 mg P.O. at bedtime p.r.n. Range is 7.5 to 30 mg.
Dosage adjustment
• Elderly or debilitated patients
Contraindications
• Hypersensitivity to drug or other benzodiazepines
• Pregnancy
Precautions
Use cautiously in:
• chronic pulmonary insufficiency, hepatic dysfunction, renal disease, psychoses, drug abuse
• history of suicide attempt or drug abuse
• elderly or debilitated patients
• breastfeeding patients
• children younger than age 15.
Administration
• Give at bedtime with or without food.
Adverse reactions
CNS: hangover, headache, dizziness, drowsiness, lethargy, fatigue, paradoxical stimulation, light-headedness, talkativeness, irritability, nervousness, confusion, euphoria, relaxed feeling, tremor, incoordination, impaired memory, nightmares, paresthesia
CV: chest pain, palpitations, tachycardia
EENT: eye irritation, pain, and swelling; photophobia; tinnitus
GI: nausea, vomiting, constipation, diarrhea, heartburn, abdominal pain, dry mouth, anorexia
Musculoskeletal: joint pain
Other: altered taste, body pain, physical or psychological drug dependence, drug tolerance
Interactions
Drug-drug. Antidepressants, antihistamines, opioid analgesics, other sedative-hypnotics: additive CNS depression
Digoxin: increased digoxin blood level, greater risk of toxicity
Probenecid: faster temazepam onset and prolonged effects
Theophylline: antagonism of temazepam's sedative effects
Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression
Drug-behaviors. Alcohol use: additive CNS depression
Smoking: increased drug metabolism
Patient monitoring
• Monitor neurologic status carefully. Check for paradoxical reactions, especially in elderly patient.
• Watch for signs and symptoms of physical and psychological drug dependence. Stay alert for drug hoarding.
Patient teaching
• Advise patient to establish effective bedtime routine, to minimize insomnia.
• Inform patient (and significant other if appropriate) that drug may cause psychological and physical dependence and should be used only as prescribed and needed.
• Caution patient to avoid driving and other hazardous activities on day after taking drug, until he knows how it affects concentration and alertness.
• Instruct patient not to drink alcohol.
• Advise patient not to smoke or use herbs without consulting prescriber.
• Instruct patient to report suspected pregnancy.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.