What is the recommended use and dosage of Temazepam (temazepam) for treating insomnia?

Temazepam for Treating Insomnia

Temazepam is recommended at a dose of 15 mg before bedtime for the short-term treatment of both sleep onset and sleep maintenance insomnia in adults, with treatment generally limited to 7-10 days. 1, 2

Dosage Recommendations

• Standard adult dose: 15 mg before bedtime
• Lower dose: 7.5 mg may be sufficient for some patients, particularly elderly or debilitated individuals
• Higher dose: 30 mg may be needed for some patients, but only after evaluating response to lower doses
• Duration: Limited to short periods (7-10 days)

Efficacy

Temazepam has demonstrated effectiveness for both sleep onset and sleep maintenance insomnia:

• Sleep latency: Significant reduction in time to fall asleep 1, 3
• Total sleep time: Mean improvement of 99 minutes compared to placebo 1
• Sleep quality: Small improvement compared to placebo 1
• Number of awakenings: Clinically significant reduction 4

Clinical Application Algorithm

1. Confirm insomnia diagnosis:

   • Difficulty falling asleep (sleep onset insomnia)
   • Difficulty staying asleep (sleep maintenance insomnia)
   • Or both

2. Select appropriate starting dose:

   • Standard adults: 15 mg
   • Elderly or debilitated patients: 7.5 mg 2, 5
   • Transient insomnia: 7.5 mg may be sufficient 2

3. Administer 30 minutes before bedtime 2, 3

4. Monitor effectiveness and side effects:

   • If inadequate response and no significant side effects, may increase to 30 mg
   • If excessive sedation, reduce to 7.5 mg

5. Limit duration of treatment:

   • Generally 7-10 days 2
   • Avoid exceeding 2-4 weeks 6

6. Discontinuation:

   • Use gradual taper to discontinue to reduce risk of withdrawal reactions 2
   • If withdrawal reactions develop, pause taper or increase to previous dosage level temporarily

Important Considerations

Benefits

• Rapid onset of action 6
• Effective for both sleep onset and sleep maintenance insomnia 1
• Medium duration of action (half-life 10-15 hours) provides good balance between efficacy and morning residual effects 2, 7
• No evidence of tolerance development with short-term use 2

Potential Harms

• Psychomotor impairment, especially in the elderly 6, 4
• Risk of falls in elderly patients 4
• Potential for dependence with prolonged use 6
• Limited evidence of daytime impairment at higher doses (30 mg) 1

Common Pitfalls to Avoid

1. Prolonged use: Avoid prescribing for more than 2-4 weeks due to risk of tolerance and dependence 6

2. Abrupt discontinuation: Always taper gradually to prevent withdrawal symptoms 2

3. Inappropriate dosing in elderly: Start with 7.5 mg in elderly patients to minimize risk of falls and cognitive impairment 2, 5, 4

4. Failure to consider timing: Temazepam should be administered 30 minutes before bedtime for optimal effect 3

5. Overlooking drug interactions: Use caution when combining with other CNS depressants

Temazepam reaches peak plasma concentrations in 1.2-1.6 hours after ingestion, which explains its effectiveness for sleep onset insomnia when taken 30 minutes before bedtime 2. Its medium duration of action makes it suitable for both sleep onset and maintenance insomnia without excessive morning residual effects 1, 6.