Is Temazepam (temazepam) suitable for an elderly patient with insomnia?

From the Guidelines

Temazepam can be used for elderly patients with sleep difficulties, but should be approached with caution, as the evidence from the American College of Physicians guideline 1 suggests that it may be associated with increased risk of side effects, including daytime sedation, confusion, impaired coordination, and falls. For elderly patients, a lower starting dose of 7.5 mg at bedtime is recommended, which can be increased to 15 mg if necessary, as stated in the guideline 1. Treatment should be limited to short-term use (generally 7-10 days) to avoid dependence and tolerance. Some key points to consider when prescribing temazepam to elderly patients include:

• Elderly patients are more sensitive to benzodiazepine effects and have increased risk of side effects, including daytime sedation, confusion, impaired coordination, and falls, as noted in the guideline 1.
• These risks are particularly concerning in patients with respiratory conditions, sleep apnea, or cognitive impairment.
• Before prescribing temazepam, non-pharmacological approaches should be tried first, including sleep hygiene education, regular sleep schedules, limiting caffeine and alcohol, and cognitive behavioral therapy for insomnia, as recommended in the guideline 1.
• If medication is necessary, the lowest effective dose should be used for the shortest duration possible, as suggested in the guideline 1.
• Regular reassessment is important to evaluate effectiveness and monitor for adverse effects, as stated in the guideline 1. It's also important to note that the evidence from the guideline 1 suggests that cognitive behavioral therapy for insomnia (CBT-I) is an effective therapy for chronic insomnia disorder and can be performed and prescribed in the primary care setting. Some benefits of CBT-I include:
• Improved sleep outcomes, such as sleep onset latency and total sleep time
• Reduced symptoms of insomnia, such as difficulty maintaining sleep and daytime fatigue
• Improved quality of life and reduced distress associated with insomnia Overall, while temazepam can be used for elderly patients with sleep difficulties, it's essential to approach its use with caution and consider alternative treatments, such as CBT-I, before prescribing medication, as recommended in the guideline 1.

From the FDA Drug Label

Controlled Trials Supporting Efficacy Temazepam improved sleep parameters in clinical studies. Residual medication effects (“hangover”) were essentially absent. Early morning awakening, a particular problem in the geriatric patient, was significantly reduced.

Temazepam may be suitable for an elderly patient with insomnia, as it has been shown to improve sleep parameters and reduce early morning awakening, a common issue in geriatric patients. However, it is essential to use caution and consider the potential risks of abuse, misuse, and addiction, as well as the possibility of physical dependence and withdrawal reactions, especially in elderly patients.

• Key considerations:
  • The patient's medical history, including any history of depression, mental illness, or suicidal thoughts
  • The potential for interactions with other medications
  • The risk of falls and other accidents due to drowsiness or dizziness
  • The need for close monitoring and regular follow-up appointments to assess the patient's response to the medication and adjust the treatment plan as needed 2 2

From the Research

Suitability of Temazepam for Elderly Patients with Insomnia

• Temazepam is a benzodiazepine, and according to 3, benzodiazepines should not be used routinely in the elderly due to potential risks and side effects.
• A study published in 4 also discourages the use of benzodiazepines, including temazepam, in the geriatric population, especially for long-term use, due to their adverse effect profile.
• The same study 4 suggests that cognitive behavioral therapy and sleep hygiene are considered initial therapy for insomnia, and temazepam should only be considered as a last resort.
• Another study 5 found that Cognitive Behavioral Therapy for Insomnia is a first-line treatment option with longer lasting therapeutic effects than treatment with pharmacologic agents alone, which further supports the idea that temazepam should not be the first choice for elderly patients with insomnia.
• Non-pharmacological interventions, such as those discussed in 6 and 7, may be a more suitable option for elderly patients with insomnia, as they have been shown to be effective and well-suited for this population.