TEMAZEPAM

TEMAZEPAM
(te-maz'e-pam)
Restoril
Classifications: anxiolytic; sedative-hypnotic; benzodiazepine;
Therapeutic:antianxiety
; sedative-hypnotic
Prototype: Lorazepam
Pregnancy Category: X
Controlled Substance: Schedule IV

Availability

7.5 mg, 15 mg, 30 mg capsules

Action

Benzodiazepine derivative with hypnotic, anxiolytic, sedative effects. Principal effect is significant improvement in sleep parameters. Minimal change in REM sleep.

Therapeutic Effect

Reduces night awakenings and early morning awakenings; increases total sleep times, absence of rebound effects.

Uses

To relieve insomnia associated with frequent nocturnal awakenings or early morning awakenings.

Contraindications

Benzodiazepine hypersensitivity; ethanol intoxication; pregnancy (category X); safety in children <18 y is not established; narrow-angle glaucoma; psychoses; lactation.

Cautious Use

Severely depressed patient or one with suicidal ideation; history of drug abuse or dependence, acute intoxication; alcoholism; COPD; liver or kidney dysfunction; older adults; sleep apnea.

Route & Dosage

Insomnia
Adult: PO 7.5–30 mg h.s.
Geriatric: PO 7.5 mg h.s.

Administration

Oral
  • Give 20–30 min before patient retires.
  • Store at 15°–30° C (59°–86° F) in tight container unless otherwise specified by manufacturer.

Adverse Effects (≥1%)

CNS: Drowsiness, dizziness, lethargy, confusion, headache, euphoria, relaxed feeling, weakness. GI: Anorexia, diarrhea. CV: Palpitations.

Interactions

Drug: Alcohol, cns depressants, anticonvulsants potentiate CNS depression; cimetidine increases temazepam plasma levels, thus increasing its toxicity; may decrease antiparkinsonism effects of levodopa; may increase phenytoin levels; smoking decreases sedative effects. Herbal: Kava, valerian may potentiate sedation.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: 30–50 min. Peak: 2–3 h. Duration: 10–12 h. Distribution: Crosses placenta; distributed into breast milk. Metabolism: In liver to oxazepam. Elimination: In urine. Half-Life: 8–24 h.

Nursing Implications

Assessment & Drug Effects

  • Be alert to signs of paradoxical reaction (excitement, hyperactivity, and disorientation) in older adults. Psychoactive drugs are the most frequent cause of acute confusion in this age group.
  • CNS adverse effects are more apt to occur in the patient with hypoalbuminemia, liver disease, and in older adults. Report promptly incidence of bradycardia, drowsiness, dizziness, clumsiness, lack of coordination. Supervise ambulation, especially at night.
  • Lab tests: Obtain liver and kidney function tests during long-term use.
  • Be alert to S&S of overdose: Weakness, bradycardia, somnolence, confusion, slurred speech, ataxia, coma with reduced or absent reflexes, hypertension, and respiratory depression.

Patient & Family Education

  • Be aware that improvement in sleep will not occur until after 2–3 doses of drug.
  • Notify physician if dreams or nightmares interfere with rest. An alternate drug or reduced dose may be prescribed.
  • Be aware that difficulty getting to sleep may continue. Drug effect is evidenced by the increased amount of rest once asleep.
  • Consult physician if insomnia continues in spite of medication.
  • Do not smoke after medication is taken.
  • Do not use OTC drugs (especially for insomnia) without advice of physician.
  • Consult physician before discontinuing drug especially after long-term use. Gradual reduction of dose may be necessary to avoid withdrawal symptoms.
  • Avoid use of alcohol and other CNS depressants.
  • Do not drive or engage in other potentially hazardous activities until response to drug is known. This drug may depress psychomotor skills and cause sedation.

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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