temazepam

Brand: Restoril

⚠ BBW Beers Criteria Prototype: diazepam

Drug Class: benzodiazepine

Drug Family: benzodiazepine

Subclass: intermediate-acting benzodiazepine hypnotic

Organ Systems: cns

Mechanism of Action

Benzodiazepine GABA-A receptor positive allosteric modulator that enhances chloride conductance; used specifically as a hypnotic for short-term management of insomnia. Intermediate half-life minimizes morning sedation compared to long-acting benzodiazepines.

GABA-A receptor (benzodiazepine site)

Indications

short-term treatment of insomnia

Contraindications

sleep apnea
severe hepatic impairment
concurrent opioids (relative)
pregnancy

Adverse Effects

Common

drowsiness
dizziness
hangover effect
anterograde amnesia
rebound insomnia on discontinuation

Serious

respiratory depression
paradoxical excitement
dependence and withdrawal
complex sleep behaviors (sleepwalking, sleep-driving — rare)

Pharmacokinetics (ADME)

Absorption	oral; well absorbed; bioavailability ~96%
Distribution	96% protein bound
Metabolism	hepatic glucuronidation (NOT CYP); no active metabolites
Excretion	renal
Half-life	8–25 hours
Onset	30 minutes
Peak	1–2 hours
Duration	6–8 hours
Protein Binding	96%
Vd	1.4 L/kg

Drug Interactions

Drug / Agent	Mechanism	Severity
opioids	additive CNS and respiratory depression	major
alcohol and CNS depressants	additive CNS depression	major

Nursing Considerations

Administer 30 minutes before bedtime; ensure patient has 7–8 hours available for sleep to minimize morning sedation.
Beers Criteria medication in elderly: avoid in all but carefully considered situations; fall risk is significant.
Limit to short-term use (7–10 days); rebound insomnia occurs on discontinuation.
Unlike most benzodiazepines, temazepam is glucuronidated (not CYP450 metabolized), making it less susceptible to CYP drug interactions.

Clinical Pearls

Temazepam's glucuronidation metabolism (avoiding CYP450) means it has fewer pharmacokinetic drug interactions than other benzodiazepines; it is preferred in elderly patients who require benzodiazepine hypnosis (if use cannot be avoided).
However, as a Beers Criteria medication in elderly, temazepam still significantly increases fall and fracture risk; non-pharmacological insomnia treatment (CBT-I) should be first-line in older adults.

Safety Profile

Pregnancy avoid

Lactation avoid

Renal Adjustment Not required

Hepatic Adjustment Required

TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Benzodiazepine Short-term Treatment Of Insomnia

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