Temazepam Should Not Be Prescribed for Tinnitus
Temazepam is not recommended for treating tinnitus and represents off-label use without evidence of benefit. The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against the routine use of anxiolytics (including benzodiazepines like temazepam) for persistent, bothersome tinnitus 1.
Why Benzodiazepines Are Not Recommended
The 2014 clinical practice guideline provides a Grade B recommendation against using anxiolytics for tinnitus, based on:
- Insufficient evidence of efficacy from systematic reviews and RCTs with methodological concerns
- Significant potential side effects that outweigh any uncertain benefits
- Risk of dependence and abuse, particularly concerning in the elderly population commonly affected by tinnitus
- Potential for medications to worsen tinnitus in some cases 1
The guideline explicitly states the goal is "to decrease the use of medications that may have no benefit and have significant potential side effects in the management of patients with tinnitus" 1.
Evidence Specific to Temazepam
The FDA label for temazepam indicates it is approved only for insomnia, with safety data limited to 2 weeks of use 2. There is no FDA-approved indication for tinnitus. The label warns of serious risks including:
- Abnormal thoughts and behavior
- Dependence and withdrawal
- Complex sleep behaviors
- Respiratory depression when combined with other CNS depressants 2
The Problem of Off-Label Benzodiazepine Overprescription
Research demonstrates that benzodiazepines are frequently overprescribed for tinnitus despite lack of evidence. A 2025 study found significant overuse of benzodiazepines in tinnitus patients, which could be reduced through proper multidisciplinary care 3. A 2015 systematic review concluded that benzodiazepine use for tinnitus "does not have a robust evidence base" 4.
What Should Be Prescribed Instead
The guideline provides clear evidence-based alternatives:
- Cognitive-behavioral therapy (CBT) - Should be recommended (based on RCTs showing preponderance of benefit) 1
- Hearing aids for patients with hearing loss - Should be recommended 1
- Sound therapy - May be recommended 1
Critical Caveat
If a patient with tinnitus has comorbid anxiety or insomnia that independently warrants treatment, benzodiazepines might be considered for those specific conditions—but not for the primary indication of treating the tinnitus itself. Even then, temazepam's FDA approval is limited to short-term insomnia treatment (≤2 weeks) 2, making it inappropriate for chronic conditions.
The evidence consistently shows that while tinnitus patients may receive benzodiazepines in practice, this represents inappropriate off-label prescribing that should be avoided in favor of evidence-based interventions like CBT 1, 3, 4.