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

Maximum Recommended Dose of Temazepam (Restoril)

The maximum recommended dose of temazepam is 30 mg for most adults and 15 mg for elderly or debilitated patients. 1

Dosage Guidelines

Temazepam is a benzodiazepine medication used primarily for the treatment of insomnia. The dosing recommendations are as follows:

• Standard adult dose: 15-30 mg taken 30-60 minutes before bedtime 2, 3
• Elderly or debilitated patients: 15 mg maximum 1, 4
• Duration of use: Short-term treatment (generally 7-10 days) is recommended due to risk of tolerance and dependence

Efficacy by Dose

The efficacy of temazepam varies by dose:

• 15 mg dose:

  • Clinically significant improvement in subjective sleep latency 2
  • Clinically significant improvement in total sleep time 2
  • Modest improvement in sleep quality (below threshold for clinical significance) 2
  • Effective for both sleep onset and sleep maintenance insomnia 2

• 30 mg dose:

  • More consistent effects on sleep staging compared to 15 mg 5
  • Significant efficacy for improving subjective sleep latency and total sleep time 2
  • May be associated with more daytime impairment than lower doses 2

Side Effects and Safety Considerations

• Common side effects: Drowsiness, dizziness, and lethargy 6

• Dose-related considerations:

  • At 15 mg: Limited evidence of adverse events in excess of placebo 2
  • At 30 mg: Increased risk of drowsiness, lethargy, and vertigo 2
  • At doses of 30 mg or more: Evidence of impaired psychomotor and cognitive function the following morning 7

• Special populations:

  • Elderly patients show increased sensitivity to adverse effects and should be limited to 15 mg maximum 4
  • Patients with liver impairment should receive lower doses 3

Clinical Pearls

• Temazepam has a relatively slow absorption profile with peak plasma concentrations occurring approximately 3 hours after ingestion 1
• The elimination half-life ranges from 10-15 hours in most adults 1
• Unlike some other benzodiazepines, temazepam has no clinically important active metabolites 7
• Due to its slower absorption profile, temazepam may be more effective for sleep maintenance than sleep onset problems 1, 6
• The American Academy of Sleep Medicine suggests temazepam as a treatment for both sleep onset and sleep maintenance insomnia 2

Monitoring

• Follow-up within 2-4 weeks to assess effectiveness and side effects 3
• Monitor for signs of tolerance, dependence, or rebound insomnia
• Consider gradual tapering when discontinuing to prevent withdrawal symptoms 3

Remember that while 30 mg is the maximum recommended dose for most adults, the lowest effective dose should be used, particularly when treating elderly patients or those with compromised liver function.