Flurazepam

Definition

Flurazepam is a benzodiazepine hypnotic (sleeping medication) that is given by mouth. It is sold in the United States under the brand name of Dalmane, but is also manufactured and sold by several companies under its generic name.

Purpose

Flurazepam is used for the short-term treatment of insomnia , which is a sleep disorder characterized by difficulty in falling or staying asleep.

Description

Flurazepam is a benzodiazepine, which means that it belongs to a class of drugs whose primary action is to reduce the patient'sanxiety, relax the skeletal muscles, and bring on sleep. Flurazepam is chemically and pharmacologically related to such other benzodiazepine hypnotics as temazepam (Restoril), triazolam (Halcion), quazepam (Doral), and estazolam . All the benzodiazepines work by enhancing the effects of a naturally occurring chemical in the body called gamma-aminobutyric acid (GABA). GABA is a neurotransmitter, or chemical that helps to conduct nerve impulses across the tiny gaps between nerve cells. GABA acts to lower the level of activity in the central nervous system; it is involved in muscle relaxation, sedation, and sleep, and plays a role in preventing seizure activity.

Flurazepam decreases the time it takes the patient to fall asleep, thus reducing the number of nighttime awakenings and increasing the length of total sleep time. The difference between a benzodiazepine like flurazepam that is used to help patients fall asleep and those that are used as tranquilizers is the way that each type acts in the brain . The sleep-inducing benzodiazepines are faster in getting to the part of the brain that controls sleep. They also reach higher levels of concentration there than the benzodiazepines that are used as tranquilizers.

Flurazepam is available in 15- and 30-mg capsules.

Recommended dosage

The usual dose of flurazepam is 15–30 mg taken by mouth at bedtime. Older or physically weakened patients are usually given the lower dose. Women who are pregnant or nursing a baby, and children younger than 15 should not be given flurazepam. In addition, the drug should not be used for longer than four weeks.

Precautions

Some of the flurazepam is metabolized (broken down) in the body to form another compound called desalkylflurazepam, which can also cause drowsiness the next day because it remains in the body for hours. This "hangover" effect is most common in people who are taking flurazepam on a daily basis. People who are taking flurazepam may not be able to operate machinery safely or drive a car the next day.

Patients who take flurazepam for several days or weeks may experience a reaction called rebound insomnia when they stop taking it. When a person takes a medication for sleep on a regular basis, the body adjusts to the presence of the drug. It tries to counteract the effects of the medication. As a result, when the person stops taking the sleeping medication, the body will take a few nights to return to its normal condition. During this period of readjustment, the person may experience a few sleepless hours each night.

The sleepiness that flurazepam brings about may be intensified if the patient drinks alcoholic beverages or takes other medications that contain central nervous system depressants. Common types of medications that may cause problems when combined with flurazepam include tranquilizers and antihistamines.

Elderly patients who are taking flurazepam should be monitored for signs of dizziness or loss of coordination. They are at increased risk of falling if they wake up and get out of bed during the night to get a drink of water or use the bathroom.

Side effects

Some people experience dizziness, daytime drowsiness, and loss of coordination while they are taking flurazepam. Elderly patients may lose their balance and fall. Less common side effects include blurred vision, nausea and vomiting, diarrhea or constipation, nightmares, and a feeling of depression.

Interactions

The effects of flurazepam are increased by other central nervous system depressants. These types of chemicals include alcohol, sedatives, and antihistamines (allergy medications). In addition, flurazepam may interact with anti-seizure medications.

Resources

BOOKS

American Society of Health-System Pharmacists. AHFS Drug Information 2002. Bethesda, MD: American Society of Health-System Pharmacists, 2002.

DeVane, C. Lindsay, Pharm.D. "Drug Therapy for Mood Disorders." In Fundamentals of Monitoring Psychoactive Drug Therapy. Baltimore, MD: Williams and Wilkins, 1990.

Jack Raber, Pharm.D.