What is the maximum recommended dose of Restoril (temazepam)?

Maximum Recommended Dose of Restoril (Temazepam)

The maximum recommended dose of temazepam (Restoril) is 30 mg for most adults, with a lower dose of 15 mg recommended for elderly or debilitated patients. 1

Dosage Guidelines

Temazepam is a 1,4-benzodiazepine medication used primarily for the treatment of insomnia. The dosage recommendations are as follows:

• Standard adult dose: 15-30 mg taken 30 minutes before bedtime 1, 2
• Elderly or debilitated patients: 7.5-15 mg taken 30 minutes before bedtime 1, 3

Pharmacokinetic Considerations

Temazepam has specific pharmacokinetic properties that influence its dosing:

• Peak plasma concentrations occur within 2-3 hours after oral ingestion 2
• Mean elimination half-life of 10-15 hours 2
• No active metabolites of clinical importance 4
• Absorbed more slowly and metabolized more quickly than flurazepam 2

Clinical Efficacy and Safety

Temazepam has been shown to be effective for:

• Sleep maintenance insomnia 1
• Reducing awakenings during the night 2
• Increasing total sleep duration 2

Research indicates that temazepam may be less effective for:

• Sleep onset insomnia (due to its relatively slow absorption) 2, 4

Safety Considerations

When prescribing temazepam at maximum doses, be aware of:

• Risk of tolerance with regular use 1
• Potential for addiction with prolonged use 1
• Possible cognitive impairment at higher doses (30 mg or more) 4
• Increased risk of adverse effects in elderly patients 3

Common Side Effects

At maximum doses, patients may experience:

• Drowsiness and sedation 5
• Dizziness 6
• Morning "hangover" effects (more common with doses of 30 mg) 4, 6

Special Populations

• Elderly patients: Maximum dose should not exceed 15 mg due to increased sensitivity and risk of falls 3, 5
• Patients with hepatic impairment: Lower doses may be required due to decreased metabolism
• Patients with respiratory conditions: Use with caution due to potential respiratory depression

Duration of Treatment

Temazepam should generally be prescribed for short-term use (7-10 days) to minimize the risk of tolerance and dependence 5. When discontinuing after prolonged use, gradual tapering is recommended to prevent withdrawal symptoms 7.

Common Pitfalls to Avoid

• Exceeding the maximum recommended dose of 30 mg
• Prescribing maximum doses to elderly patients
• Long-term continuous use without periodic reassessment
• Abrupt discontinuation after prolonged use
• Combining with other CNS depressants, which may increase risk of respiratory depression

When considering maximum doses, always weigh the potential benefits against risks of side effects and dependence, particularly in vulnerable populations.