Temazepam 💊
Related Subjects:
|Benzodiazepines
|Zopiclone
|Diazepam
|Lorazepam
⚠️ Temazepam is a Schedule 3 Controlled Drug (safe-custody requirements apply). It is also a specified drug under drug-driving law (limit 1,000 micrograms/L). Use it only for short-term treatment of severe insomnia (usually ≤2–4 weeks), and avoid in older people where possible because of falls and confusion.
📖 About
- Short-to-intermediate-acting benzodiazepine (half-life ~8–15 hours) with no active metabolites, so less hangover than nitrazepam or diazepam.
- First-line management of insomnia is non-drug (sleep hygiene, CBT-I).
- Always check the BNF for up-to-date prescribing information.
⚙️ Mode of Action
- Positive allosteric modulator at the GABA-A receptor benzodiazepine site → ↑ frequency of chloride channel opening → neuronal inhibition.
- Effects: hypnotic, anxiolytic, muscle relaxant, anticonvulsant, amnesic.
🎯 Indications
- Insomnia that is severe, disabling or causing extreme distress - short term only.
- Pre-operative sedation / premedication (including before procedures).
💊 Dose (adult, by mouth)
| Indication | Adult | Older or debilitated |
|---|
| Insomnia | 10–20 mg at bedtime; up to 30–40 mg in exceptional circumstances | 5–10 mg at bedtime |
| Premedication | 10–20 mg 1 hour before the procedure (up to 30 mg) | 10 mg |
- Prescribe the smallest quantity needed; review early and plan a taper if used beyond 2 weeks.
🔄 Interactions
- Opioids: profound sedation and respiratory depression - avoid combining where possible (MHRA 2020).
- Alcohol, antihistamines, antipsychotics, gabapentinoids, other hypnotics: additive CNS depression.
- Clozapine: risk of collapse and respiratory arrest.
- Little CYP interaction (metabolised by glucuronidation).
⚠️ Cautions
- Elderly: falls, fractures, confusion, delirium.
- Dependence and tolerance; history of substance misuse.
- Depression (may unmask suicidality), personality disorder.
- Muscle weakness, chronic respiratory disease, hepatic or renal impairment.
- Pregnancy (neonatal withdrawal, floppy infant) and breastfeeding.
- Driving: warn about impaired alertness and the drug-driving law.
🚫 Contraindications
- Respiratory depression, acute pulmonary insufficiency.
- Marked neuromuscular respiratory weakness, including unstable myasthenia gravis.
- Sleep apnoea syndrome.
- Severe hepatic impairment.
- Not for chronic psychosis or as sole treatment of depression or anxiety with depression.
💥 Side Effects
- Drowsiness and next-day sedation, dizziness, ataxia, confusion, anterograde amnesia.
- Paradoxical agitation or aggression (more likely in older people and children).
- Respiratory depression (especially with opioids or alcohol).
- Dependence and withdrawal (rebound insomnia, anxiety, tremor, seizures) - taper gradually.
📚 References
