What is the recommended dosage and treatment duration for temazepam (a benzodiazepine) in patients with insomnia?

Temazepam Dosage and Treatment Duration for Insomnia

For patients with insomnia, temazepam should be prescribed at a dose of 15 mg before bedtime for short-term use (7-10 days), with dosage adjustments to 7.5 mg for elderly or debilitated patients and up to 30 mg for those requiring higher doses. 1

Recommended Dosage

The dosing of temazepam should follow a structured approach:

• Standard adult dose: 15 mg before bedtime 2, 1
• Lower dose: 7.5 mg may be sufficient for some patients, particularly:
  • Elderly patients
  • Debilitated patients
  • Patients with transient insomnia 1, 3
• Higher dose: 30 mg may be needed for patients with more severe insomnia 1, 4

Treatment Duration

Temazepam is specifically indicated for short-term treatment of insomnia:

• Generally 7 to 10 days 1
• Clinical trials supporting efficacy were only 2 weeks in duration 1
• Long-term use is not recommended due to risks of tolerance and dependence

Efficacy for Different Types of Insomnia

Temazepam has demonstrated effectiveness for:

• Sleep maintenance insomnia: Shows significant improvement in:

  • Total sleep time (mean improvement of 99 minutes compared to placebo) 2
  • Sleep efficiency (13.3% greater than placebo) 2
  • Wake after sleep onset (reduction of 28.1 minutes) 2

• Sleep onset insomnia: Evidence is less consistent, with some studies showing limited effect on sleep latency 5, likely due to its relatively slow absorption (peak plasma concentrations within 3 hours after ingestion) 5

Discontinuation Protocol

To minimize withdrawal reactions:

• Use a gradual taper when discontinuing temazepam
• If withdrawal reactions develop, consider pausing the taper or temporarily increasing to the previous dosage level
• Subsequently decrease the dosage more slowly 1

Special Populations

Elderly Patients

• Start with 7.5 mg dose 1, 3
• Studies show 7.5 mg is effective in elderly insomniacs with minimal adverse effects 3
• Significantly improves total wake time compared to baseline 3

Patients with Substance Use History

• Consider non-scheduled alternatives like ramelteon or low-dose doxepin instead 6
• If temazepam is necessary, use the lowest effective dose for the shortest duration

Adverse Effects

Temazepam has a relatively favorable side effect profile:

• Most common adverse effects: drowsiness, dizziness, and lethargy 7
• Incidence of adverse effects is generally low (7.8% in one study) 8
• Severity of adverse events is typically mild and decreases over the course of treatment 8
• Higher doses (30 mg) may be associated with greater effects on sleep staging 4
• Limited evidence of hangover effects with 15 mg and 30 mg doses 7

Important Clinical Considerations

• Temazepam has a half-life of 10-15 hours, which is shorter than flurazepam but longer than some other sleep medications 5
• No consistent evidence of tolerance development or rebound insomnia with short-term use 5, 3
• Combining temazepam with cognitive-behavioral therapy (CBT) may allow for lower medication doses with comparable sleep improvements 8
• Reassess sleep quality within 2-4 weeks of starting treatment 6
• Periodic medication-free intervals should be considered to assess continued need 6

Pitfalls and Caveats

• Avoid use in patients with respiratory conditions due to risk of respiratory depression 6
• Benzodiazepines should be avoided in elderly patients with cognitive impairment 6
• Do not abruptly discontinue after regular use due to risk of withdrawal symptoms 1
• Not recommended for long-term management of chronic insomnia; cognitive-behavioral therapy for insomnia (CBT-I) is preferred for long-term management 6
• Temazepam may not be ideal for patients primarily struggling with sleep onset due to its relatively slow absorption 5