• Short-term management of insomnia (<4 wk).

Contraindicated in:

• Hypersensitivity
• Cross-sensitivity with other benzodiazepines may exist
• Pre-existing CNS depression
• Severe uncontrolled pain
• Angle-closure glaucoma
• Impaired respiratory function
• Sleep apnea
• OB: Neonates born to mothers taking temazepam may experience withdrawal effects
• Lactation: Infants may become sedated. Discontinue drug or bottle feed.

Use Cautiously in:

• Pre-existing hepatic dysfunction
• History of suicide attempt or drug addiction
• Geri: Elderly patients have increased sensitivity to benzodiazepines. Appears on Beers list and is associated with increased risk of falls (↓ dose required)
• Pedi: Safety and effectiveness not established.

CNS: abnormal thinking, behavior changes, hangover, dizziness, drowsiness, hallucinations, lethargy, paradoxic excitation, sleep — driving.

EENT: blurred vision.

GI: constipation, diarrhea, nausea, vomiting.

Derm: rash.
Misc: physical dependence, psychological dependence, tolerance.

Drug-Drug:

• Use with opioids or other CNS depressants, including other benzodiazepines, non-benzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
• May ↓ efficacy of levodopa.
• Rifampin or smoking↑ metabolism and may ↓ effectiveness of temazepam.
• Probenecid may prolong effects of temazepam.
• Sedative effects may be ↓ by theophylline.

Drug-Natural Products:

• Concomitant use of kava-kava, valerian, skullcap, chamomile, or hops can ↑ CNS depression.

(Generic available)

• Capsules: 7.5 mg; 15 mg; 22.5 mg; 30 mg;
  • Cost: Generic—
    - 7.5 mg; price/quantity: $995.03/100
    - 15 mg; price/quantity: $73.45/100
    - 22.5 mg; price/quantity: $298.21/30
    - 30 mg; price/quantity: $88.45/100.

• PO (Adults): 15–30 mg at bedtime initially if needed; some patients may require only 7.5 mg.
• PO (Geriatric Patients or Debilitated Patients): 7.5 mg at bedtime.

Restoril

• Acts at many levels in the CNS, producing generalized depression.
• Effects may be mediated by GABA, an inhibitory neurotransmitter.

• Relief of insomnia.

Therapeutic Classification: sedative/hypnotics

Pharmacologic Classification: benzodiazepines

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed; crosses blood-brain barrier. Probably crosses the placenta and enters breast milk. Accumulation of drug occurs with chronic dosing.

Protein Binding: 96%.

Metabolism/Excretion: Metabolized by the liver.

Half-life: 10–20 hr.

Schedule IV (C-IV)

(sedation)

• Instruct patient to take temazepam as directed. Teach sleep hygiene techniques (dark room, quiet, bedtime ritual, limit daytime napping, avoidance of nicotine and caffeine). If less effective after a few weeks, consult health care professional; do not increase dose.
• May cause daytime drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Geri: Instruct patient and family how to reduce falls risk at home.
• Advise patient to avoid the use of alcohol and other CNS depressants and to consult health care professional before using OTC preparations that contain antihistamines or alcohol.
• Caution patient that complex sleep-related behaviors (sleep-driving, making phone calls, preparing and eating food, having sex, sleep walking) may occur while asleep. Inform patient to notify health care professional if sleep-related behaviors, (may include sleep-driving — driving while not fully awake after ingestion of a sedative-hypnotic product, with no memory of the event) occur.
• Emphasize the importance of follow-up appointments to monitor progress.
• Refer for psychotherapy if ineffective coping is basis for sleep pattern disturbance.
• Advise patient to take temazepam only if able to devote 8 hr to sleep.
• Advise patient to inform health care professional if pregnancy is planned or suspected and to avoid breast feeding while taking temazepam.

tem-AZ-a-pam