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
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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 1530 mg h.s. Geriatric: PO 15 mg h.s.
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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: 1545 min.
Duration: 78 h.
Distribution: Crosses bloodbrain barrier and placenta; distributed into breast milk.
Metabolism: In liver to active metabolites.
Elimination: Primarily in urine.
Half-Life: 47100 h.
Nursing Implications
Assessment & Drug Effects
- Monitor effectiveness. Hypnotic effect is apparent on second or third night of consecutive use and continues 12 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.