Category:

• Hypnotic

Description:

• Benzodiazepine hypnotic (DEA Schedule IV)

Indications:

• Insomnia

Precautions:

• Pregnancy category X; may cause sedation and poor feeding in nursing infant

• Anemia, hepatic/renal disease, suicidal individuals

• Drug abuse, elderly, depression, psychosis, children <18 years

• Acute narrow-angle glaucoma, seizure disorders, lung disease

Adverse Reactions (Side Effects):

• CNS: anxiety, confusion, daytime sedation, dizziness, drowsiness, headache, irritability, lethargy, lightheadedness, rebound insomnia

• CV: chest pain, hypotension, tachycardia

• GI: abdominal pain, anorexia, constipation, diarrhea, heartburn, nausea, vomiting

• HEME: granulocytopenia (rare), leukopenia

• RESP: respiratory depression, sleep apnea

Dosage:

Administered orally

• Adult:   PO 15-30mg at bedtime; 7.5mg at bedtime may be sufficient for elderly or debilitated patients

Drug interactions:

• Cimetidine, disulfiram: increased benzodiazepine levels

• Clozapine: possible increased risk of cardiorespiratory collapse

• Ethanol: adverse psychomotor effects

• Rifampin: reduced benzodiazepine levels