temazepam

(te maz' e pam)

Apo-Temazepam (CAN), Novo-Temazepam (CAN), Restoril

Pregnancy Category X
Controlled Substance C-IV

Drug classes
Benzodiazepine
Sedative-hypnotic

Therapeutic actions
Exact mechanisms of action not understood; acts mainly at subcortical levels of the CNS,
leaving the cortex relatively unaffected; main sites of action may be the limbic system
and mesencephalic reticular formation; benzodiazepines potentiate the effects of gamma-
aminobutyrate (GABA), an inhibitory neurotransmitter.

Indications
• Insomnia characterized by difficulty falling asleep, frequent nocturnal
awakenings, or early morning awakening
• Recurring insomnia or poor sleeping habits
• Acute or chronic medical situations requiring restful sleep

Contraindications and cautions

• Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute
narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with
depression of vital signs, pregnancy (risk of congenital malformations, neonatal
withdrawal syndrome), labor and delivery ("floppy infant" syndrome), lactation
(infants may become lethargic and lose weight).
• Use cautiously with impaired liver or kidney function, debilitation, depression,
suicidal tendencies.

Available forms
Capsules—7.5, 15, 30 mg

Dosages
ADULTS
15–30 mg PO before retiring.
PEDIATRIC PATIENTS
Not for use in patients < 18 yr.
GERIATRIC OR DEBILITATED PATIENTS
Initially, 15 mg PO; adjust dosage until individual response is determined.

Pharmacokinetics
Route Onset Peak
Oral Varies 1.2–1.6 hr
Metabolism: Hepatic; T1/2: 10–20 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy,
fatigue, light-headedness, disorientation, restlessness, confusion, crying, delirium,
headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo,
euphoria, nervousness, difficulty concentrating, vivid dreams, psychomotor
retardation, extrapyramidal symptoms, mild paradoxical excitatory reactions
during first 2 wk of treatment (especially in psychiatric patients, aggressive
children, and with high dosage), visual and auditory disturbances, diplopia,
nystagmus, depressed hearing, nasal congestion
• CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension,
palpitations, edema
• Dependence: Drug dependence with withdrawal syndrome when drug is
discontinued
• Dermatologic: Urticaria, pruritus, rash, dermatitis
• GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting,
difficulty in swallowing, gastric disorders, elevations of blood enzymes; hepatic
dysfunction, jaundice
• GU: Incontinence, urinary retention, changes in libido, menstrual irregularities
• Hematologic: Decreased Hct (primarily with long-term therapy), blood
dyscrasias
• Other: Hiccups, fever, diaphoresis, paresthesias, muscular disturbances,
gynecomastia

Interactions
Drug-drug
• Increased CNS depression with alcohol and other CNS depressants (eg,
barbiturates, opioids)
• Decreased sedative effects with theophylline, aminophylline, dyphylline,
oxitriphylline

Nursing considerations
Assessment
• History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle
glaucoma; shock, coma; acute alcoholic intoxication; pregnancy, lactation,
impaired liver or kidney function, debilitation, depression, suicidal tendencies
• Physical: Skin color, lesions; T; orientation, reflexes, affect, ophthalmologic
exam; P, BP; R, adventitious sounds; liver evaluation, abdominal exam, bowel
sounds, normal output; CBC, liver and renal function tests

Interventions
 • Taper dosage gradually after long-term therapy, especially in patients with
epilepsy.
• Caution patient to avoid pregnancy while taking this drug; advise patient to use
barrier contraceptives.
• Prolonged therapy is generally not recommended.

Teaching points
• Take drug exactly as prescribed.
• During long-term therapy, do not stop taking this drug without consulting your
health care provider.
• Avoid pregnancy while taking this drug; serious fetal harm could occur. Using
barrier contraceptives is advised.
• Nocturnal sleep may be disturbed for several nights after discontinuing the drug.
• These side effects may occur: Drowsiness, dizziness (may lessen; avoid driving or
engaging in other dangerous activities); GI upset (take drug with water);
depression, dreams, emotional upset, crying.
• Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions,
palpitations, swelling of the extremities, visual changes, difficulty voiding.

Adverse effects in Italic are most common; those in Bold are life-threatening.