FLURAZEPAM HYDROCHLORIDE

FLURAZEPAM HYDROCHLORIDE
(flure-az'e-pam)
Apo-Flurazepam , Dalmane, Novoflupam 
Classifications: anxiolytic; sedative-hypnotic; benzodiazepine;
Therapeutic: sedative-hypnotic
; antianxiety
Prototype: Lorazepam
Pregnancy Category: X
Controlled Substance: Schedule IV

Availability

15 mg, 30 mg capsules

Action

Benzodiazepine derivative, with hypnotic activity equal to or greater than that produced by barbiturates. Benzodiazepines enhance the GABA-benzodiazepine receptor complex. GABA is an inhibitory neurotransmitter involved in anxiolytic and sedative effects. Flurazepam appears to act at limbic and subcortical levels of CNS to produce sedation, skeletal muscle relaxation, and anticonvulsant effects.

Therapeutic Effect

Reduces sleep induction time; produces marked reduction of stage 4 sleep (deepest sleep stage) while at the same time increasing duration of total sleep time.

Uses

Hypnotic in management of all kinds of insomnia (e.g., difficulty in falling asleep, frequent nocturnal awakening or early morning awakening or both). Also for treatment of poor sleeping habits.

Contraindications

Prolonged administration; sleep apnea; benzodiazepine hypersensitivity; ethanol intoxication; COPD, sleep apnea; major depression or psychosis; intermittent porphyria; acute narrow-angle glaucoma; children <15 y; pregnancy (category X), lactation.

Cautious Use

Impaired renal or hepatic function; mental depression, psychoses, history of suicidal tendencies, bipolar disorder; addiction-prone individuals; older adult or debilitated patients; COPD.

Route & Dosage

Sedative, Hypnotic
Adult (≥15 y): PO 15–30 mg h.s.
Geriatric: PO 15 mg h.s.

Administration

Oral
  • Give once patient is in bed and ready to fall asleep.
  • Store in light-resistant container with childproof cap at 15°–30° C (59°–86° F) unless otherwise specified.

Adverse Effects (≥1%)

CNS: Residual sedation, drowsiness, light-headedness, dizziness, ataxia, headache, nervousness, apprehension, talkativeness, irritability, depression, hallucinations, nightmares, confusion, paradoxic reactions: excitement, euphoria, hyperactivity, disorientation, coma (overdosage). Special Senses: Blurred vision, burning eyes. GI: Heartburn, nausea, vomiting, diarrhea, abdominal pain. Body as a Whole: Immediate allergic reaction, hypotension, granulocytopenia (rare), jaundice (rare).

Diagnostic Test Interference

Flurazepam may increase serum levels of total and direct bilirubin, alkaline phosphatase, AST, and ALT. False-negative urine glucose reactions may occur with Clinistix and Diastix; no effect with TesTape.

Interactions

Drug: Alcohol, cns depressants, anticonvulsants potentiate CNS depression; cimetidine, disulfiram may increase flurazepam levels, thus increasing its toxicity. Herbal: Kava, valerian may potentiate sedation.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: 15–45 min. Duration: 7–8 h. Distribution: Crosses blood–brain barrier and placenta; distributed into breast milk. Metabolism: In liver to active metabolites. Elimination: Primarily in urine. Half-Life: 47–100 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor effectiveness. Hypnotic effect is apparent on second or third night of consecutive use and continues 1–2 nights after drug is stopped (drug has a long half-life).
  • Supervise ambulation. Residual sedation and drowsiness are relatively common. Excessive drowsiness, ataxia, vertigo, and falling occur more frequently in older adults or debilitated patients.
  • Monitor drug ingestion if patient has a history of drug abuse. Prolonged use of large doses can result in psychic and physical dependence.
  • Lab tests: Obtain blood counts and liver and kidney function with repeated use.
  • Be aware that withdrawal symptoms have occurred 3 d after abrupt discontinuation after prolonged use and include worsening of insomnia, dizziness, blurred vision, anorexia, GI upset, nasal congestion, paresthesias.

Patient & Family Education

  • Avoid potentially hazardous activities until response to drug is known.
  • Avoid alcohol. Concurrent ingestion with flurazepam intensifies CNS depressant effects; symptoms may occur even when alcohol is ingested as long as 10 h after last flurazepam dose.
  • Be aware of the possible additive depressant effects when drug is combined with barbiturates, tranquilizers, or other CNS depressants.
  • Do not change dose intervals or dosage. Do not take for a self-diagnosed problem.
  • Ask physician about the desirability of discontinuing the drug if you become or intend to become pregnant during therapy.
  • Note: Prolonged use of this hypnotic is inadvisable because insomnia is usually transient.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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