Names and pronunciation
(te-maz′e-pam) Restoril
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Drug reference
(te-maz′e-pam) Restoril
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Func. class.: Sedative/hypnotic
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Chem. class.: Benzodiazepine, short to intermediate acting Controlled Substance Schedule IV (USA), Schedule F (Canada)
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Do not confuse: Restoril/RisperDAL
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ACTION: Produces CNS depression at limbic, thalamic, hypothalamic levels of the CNS; may be mediated by neurotransmitter γ-aminobutyric acid (GABA); results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action
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USES: Insomnia, short-term treatment (generally 7-10 days)
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CONTRAINDICATIONS: Preg- nancy, breastfeeding, hypersensitivity to benzodiazepines Precautions: Children <15 yr, geriat- ric patients, anemia, renal/hepatic dis- ease, suicidal individuals, drug abuse, psychosis, acute closed-angle glau- coma, seizure disorders, angioedema, sleep-related behaviors (sleepwalk- ing), intermittent porphyria, COPD, dementia, myasthenia gravis
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Black Box Warning: Coadministration with other CNS depressants, abrupt dis- continuation, substance abuse Black Box Warning: Avoid use with CNS depressants; serious CNS depression may result • Store in tight container in cool envi- ronment Black Box Warning: Increase: action of both products—alcohol, CNS depressants Increase: effect of temazepam—probenecid Decrease: effect of antacids, theophyl- line, rifAMPin Drug/Herb Increase: CNS depression—hops, kava, valerian, chamomile, skullcap Drug/Food Decrease: temazepam effect—caffeine Drug/Lab Test Increase: ALT, AST Black Box Warning: To avoid alcohol in- gestion, other CNS depressants • That effects may take 2 nights for ben- efits to be noticed • To take as directed; not to increase dose unless approved by prescriber • To limit to 7-10 days of continuous use • About alternative measures to im- prove sleep: reading, exercise several hours before bedtime, warm bath, warm milk, TV, self-hypnosis, deep breathing • Not to discontinue abruptly, withdraw gradually • That complex sleep-related behav iors may occur: sleep driving/eating/ walking • That hangover, memory impairment are common in geriatric patients but less common than with barbiturates • To notify prescriber if pregnancy is planned or suspected; to use contracep tion while taking this product; not to use in pregnancy; to use caution in breast feeding, excretion unknown
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SIDE EFFECTS CNS: Lethargy, drowsiness, daytime sedation, dizziness, confusion, light- headedness, headache, anxiety, irritabil- ity, complex sleep-related reactions (sleep driving, sleep eating), fatigue CV: Chest pain, pulse changes, hypotension EENT: Blurred vision RESP: Apnea, respiratory depression, increased bronchial secretions GI: Nausea, vomiting, diarrhea, heart- burn, abdominal pain, constipation, anorexia SYST: Severe allergic reactions
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INTERACTIONS Increase: effects of cimetidine, disulfi- ram, oral contraceptives
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TREATMENT OF OVERDOSE: monitor electrolytes, VS HIGH ALERT
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DOSAGE AND ROUTES • Adult: PO 7.5 to 30 mg at bedtime • Geriatric: PO 7.5 mg at bedtime
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Available forms: Caps 7.5, 15, 22.5, 30 mg
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Administer: • 15-30 min before bedtime for sleep- lessness • Without regard to food
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Assess: • Mental status: mood, sensorium, af- fect, memory (long, short), orientation • Sleep patterns: falling asleep, staying asleep, baseline, periodically • Dependency: restrict amount given to patient, assess for physical/psycho logical dependency; high-level risk for abuse • Fall risk: Assistance with ambulation after receiving dose • Beers: avoid in older adults; in- creased sensitivity to benzodiazepines and decreased metabolism; may cause delirium
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Evaluate: • Therapeutic response: ability to sleep at night, decreased early morning awak- ening if taking product for insomnia
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid driving, other activities re- quiring alertness until stabilized; may cause dizziness, drowsiness
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PHARMACOKINETICS Onset 30 min, peak 1-2 hr, duration 6-8 hr, half-life 10-20 hr, metabolized by liver, excreted by kidneys, crosses pla- centa, excreted in breast milk, 98% pro- tein binding
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• Geriatric: PO 7.5 mg at bedtime
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