Is it better to taper or abruptly discontinue Temazepam (Temazepam) 20mg after 5 nights of use?

From the Guidelines

It is better to taper Temazepam 20mg after 5 nights of use rather than abruptly discontinuing it.

Rationale

• The evidence suggests that gradual reduction of benzodiazepines is recommended to minimize the risk of rebound or withdrawal symptoms 1.
• A study by Mugunthan and colleagues suggests withdrawing 25% of the daily benzodiazepine dose each week, but notes that withdrawal should often be more gradual 1.
• The EMPOWER trial demonstrated success with a gradual reduction over many weeks to attain success in stopping benzodiazepines 1.
• Abrupt discontinuation of benzodiazepines can lead to difficulties such as dyskinesias, parkinsonian symptoms, dystonias, and neuroleptic malignant syndrome, although this is more commonly associated with antipsychotics, the principle of gradual withdrawal applies to benzodiazepines as well 1.
• In the context of real-life clinical medicine, it is prudent to err on the side of caution and opt for a gradual taper to minimize potential discontinuation effects.

Tapering Strategy

• Consider reducing the dose of Temazepam by 25% every week, but be prepared to adjust the taper schedule based on the patient's response and any withdrawal symptoms that may occur 1.
• Monitor the patient closely for any signs of withdrawal or rebound symptoms and be prepared to re-escalate dosing if necessary 1.

From the FDA Drug Label

To reduce the risk of withdrawal reactions, use a gradual taper to discontinue temazepam or reduce the dosage (a patient-specific plan should be used to taper the dose) If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the previous tapered dosage level Subsequently decrease the dosage more slowly Abrupt discontinuation or rapid dosage reduction of temazepam after continued use , or administration of flumazenil (a benzodiazepine antagonist) may precipitate acute withdrawal reactions, which can be life-threatening (e.g., seizures)

It is recommended to taper Temazepam (Temazepam) 20mg after 5 nights of use, rather than abruptly discontinuing it, to reduce the risk of withdrawal reactions. A gradual taper should be used, with a patient-specific plan, to minimize the risk of adverse reactions, including seizures 2, 2, 2.

From the Research

Tapering vs Abrupt Discontinuation of Temazepam

• The decision to taper or abruptly discontinue Temazepam after 5 nights of use depends on various factors, including the patient's medical history, dosage, and individual response to the medication.
• A study published in 1989 3 compared abrupt versus gradual withdrawal of Temazepam in elderly hospitalized patients and found no significant difference in mean hours of nightly sleep between the two groups.
• Another study from 1994 4 evaluated the effects of Temazepam 7.5 mg on sleep in elderly insomniacs and found no significant increase in wakefulness after drug withdrawal, suggesting a low propensity for rebound insomnia.
• However, a study from 1991 5 found that even brief and intermittent use of Temazepam can produce rebound insomnia after abrupt withdrawal, although this effect was more variable compared to triazolam.
• A study from 2005 6 suggested that N-of-1 trials can be valuable in helping patients reduce or stop their Temazepam use, but the results regarding the efficacy of Temazepam varied across patients.

Considerations for Discontinuation

• The risk of rebound insomnia and other withdrawal symptoms should be considered when discontinuing Temazepam.
• Gradual tapering may be recommended to minimize the risk of withdrawal symptoms, although the evidence is not conclusive.
• The patient's individual response to the medication and their medical history should be taken into account when deciding on a discontinuation strategy.
• Studies have shown that alternative therapies, such as sedative antihistamines and chloral hydrate, may be useful in helping patients stop their use of hypnotic agents 7.