Adult Dosing
Short-term management of insomnia
- Usual dose: 1-2 mg PO qhs prn
- Start 1 mg PO qhs, although some patients may require an initial 2-mg dose; may increase gradually to 2 mg PO if clinically indicated
- Small, debilitated geriatric patients: Start 0.5 mg PO qhs
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Symptomatic treatment of insomnia should be started after careful evaluation of the patient because sleep disturbances may be the presenting feature of a physical and/or psychiatric disorder. Failure of insomnia to remit after 7-10 days of therapy may indicate presence of a primary psychiatric and/or medical illness which should be evaluated
- Worsening of insomnia or the emergence of new thinking or behavior abnormalities may occur during the course of treatment
- Complex behaviors including sleep-driving, preparing and eating food, making phone calls, or having sex may occur with the use of the drug at therapeutic doses. Concomitant use of alcohol and other CNS depressants increases the risk of such behaviors; discontinue the drug if such events occur
- Angioedema involving the tongue, glottis or larynx, suggestive of anaphylaxis, may occur after taking the first or subsequent doses of estazolam and could be fatal; do not restart the drug in patients who develop angioedema
- Symptoms such as dyspnea, throat closing, or nausea and vomiting have been reported in some patients
- Patients should avoid engaging in hazardous activities requiring complete mental alertness, such as driving a motor vehicle or operating machinery, during therapy because of its CNS depressant effects
- Caution patients about possible combined effects with alcohol and other CNS depressant drugs
- Amnesia, paradoxical reactions (e.g., excitement, agitation, etc.) and other adverse behavioral effects may occur unpredictably
- Withdrawal signs and symptoms may occur following rapid reduction or abrupt discontinuation. If treatment is to be discontinued or the dose reduced after prolonged therapy, gradually taper the dose
- Avoid therapy in patients receiving very potent inhibitors of CYP3A such as ketoconazole and itraconazole; exercise caution and consider appropriate dosage reduction in patients using drugs that inhibit CYP3A to a lesser, but still a significant degree
- Impaired motor and/or cognitive performance attributable to the accumulation of benzodiazepines and their active metabolites following several days of repeated use at their recommended doses may be a concern in certain vulnerable patients
- Patients with compromised respiratory function may be at increased risk of respiratory depression and should be monitored appropriately
- Use with caution in patients exhibiting signs and symptoms of depression. Suicidal tendencies may be present in such patients; prescribe the least amount of drug that is feasible at any one time
- Estazolam, like other sedative-hypnotics, is a federally controlled substance (CIV) and can be abused or lead to dependence. These drugs should be kept in a safe place to prevent abuse and misuse; selling or giving away these drugs is considered illegal
- Patients should inform their physicians if they have ever abused or been dependent on alcohol, prescription medicines, or street drugs
- Monitor periodic blood counts, urinalyses, and blood chemistry
Cautions: Use cautiously in
- Hepatic impairment
- Renal impairment
- History of alcohol or drug abuse
- Elderly of debilitated patients
- Smoking habit changes
- History of seizures
- Sleep apnea
- Pulmonary impairment
Pregnancy Category:X
Breastfeeding: Because of its long duration of action, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 7 March 2011). As per manufacturer's data, use not recommended in nursing mothers.
Pricing data from www.DrugStore.com in U.S.A.
- Estazolam 1 MG TABS [Bottle] (WATSON LABS)
30 mg = $24.99
60 mg = $46.99 - Estazolam 2 MG TABS [Bottle] (WATSON LABS)
30 mg = $27.97
60 mg = $51.93
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
