Recommended Dosing for Restoril (Temazepam) in Insomnia Treatment
The recommended usual adult dose of Restoril (temazepam) for insomnia is 15 mg taken before bedtime, though 7.5 mg may be sufficient for some patients, particularly for transient insomnia, while others may need up to 30 mg. 1
Dosage Recommendations by Population
- Standard adult dosing: 15 mg before bedtime 1
- Elderly or debilitated patients: Initial dose of 7.5 mg until individual responses are determined 1, 2
- Transient insomnia: 7.5 mg may be sufficient to improve sleep parameters 1, 3
- Maintenance insomnia: Doses up to 30 mg may be required for patients with significant sleep maintenance difficulties 4, 1
Efficacy by Dose
7.5 mg Dose
- Effective for transient insomnia, showing significant improvement in total sleep time and sleep efficiency 3
- In elderly patients, significantly reduces total wake time compared to baseline with minimal adverse effects 5
- May be sufficient for many patients as an initial dose 1
15 mg Dose
- Increases total sleep time by approximately 64.4 minutes compared to placebo 4
- Improves sleep efficiency by approximately 14.1% versus placebo 4
- Associated with moderate reduction in number of awakenings 4
- Shows minimal adverse effects compared to placebo 4, 2
20 mg Dose
- Reduces subjective sleep latency by 23-29 minutes compared to placebo 4
- Increases total sleep time by 18-78 minutes versus placebo 4
- Improves sleep quality ratings compared to placebo 4
30 mg Dose
- Increases total sleep time by approximately 53-54.6 minutes versus placebo 4
- Significantly reduces number of awakenings (1.0-1.24 fewer awakenings compared to placebo) 4
- Associated with more daytime impairment than lower doses 4, 2
Adverse Effects
- 15 mg dose: No notable increase in adverse effects versus placebo; minimal daytime impairment 4, 2
- 20 mg dose: Modest increase in headache, blurred vision, depression and confusion, though frequency of these events is low overall 4
- 30 mg dose: Higher incidence of drowsiness, lethargy, and vertigo; potential daytime impairment on psychomotor tests 4
- Common adverse effects across all doses include drowsiness, dizziness, and lethargy, but these typically decrease over the course of treatment 2, 6
Special Considerations
- Discontinuation: Use a gradual taper to discontinue temazepam or reduce the dosage to minimize withdrawal reactions 1
- Duration of treatment: Temazepam is considered safe for older adults over an 8-week treatment period, with few adverse effects and behavioral tolerance developing over time 2
- Pharmacokinetics: Peak plasma concentrations occur within 3 hours after oral ingestion with a mean half-life of 10-15 hours 7
- Sleep onset issues: Temazepam may be less effective for reducing sleep latency compared to other sleep parameters due to its relatively slower absorption 7, 6
Clinical Pearls
- For patients with a history of addiction, consider alternative medications like ramelteon (8 mg) for sleep onset insomnia 8
- Combining temazepam with cognitive-behavioral therapy may allow for lower dosing (average 16 mg vs 20 mg) with comparable sleep improvements 2
- Temazepam has no long-acting metabolites and typically does not affect waking function following bedtime use 7
- The American Academy of Sleep Medicine found that benefits outweigh harms particularly for the 15 mg dose 4