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Pharmacologic class: Benzodiazepine
Therapeutic class: Sedative-hypnotic
Controlled substance IV
Pregnancy risk category X
Depresses CNS at limbic, thalamic, and hypothalamic levels by enhancing inhibitory neurotransmitter effect of gamma-aminobutyric acid on neuronal excitability
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
• Elderly or debilitated patients
• Hypersensitivity to drug or other benzodiazepines
• Preexisting CNS depression
• Angle-closure glaucoma
• Pregnancy or breastfeeding
Use cautiously in:
• hepatic dysfunction
• history of suicide attempt or drug dependence
• elderly patients
• children younger than age 15 (safety not established).
• Before starting therapy, evaluate patient's mental status and check kidney and liver function tests and CBC.
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
Other: abnormal taste, hangover, physical or psychological drug dependence, drug tolerance
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
• 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.
☞ 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.