Temazepam (Restoril) Dosing for Insomnia
The recommended dose of temazepam for insomnia is 15 mg before bedtime for most adults, with 7.5 mg sufficient for some patients (especially elderly or debilitated) and others potentially needing up to 30 mg. 1
Dosing Recommendations
- For most adults with insomnia, start with 15 mg before bedtime 2, 1
- For elderly or debilitated patients, start with 7.5 mg until individual responses are determined 1, 3
- For transient insomnia, 7.5 mg may be sufficient to improve sleep latency 1, 4
- Some patients may require up to 30 mg for adequate effect 1
Efficacy by Dose
15 mg Dose
- Increases total sleep time by approximately 99 minutes compared to placebo 2
- Shows small improvement in sleep quality compared to placebo 2
- Improves both subjective and objective sleep latency 2
- Has minimal adverse effects compared to placebo 2
7.5 mg Dose
- Effective in elderly patients with short-term use 3
- Reduces total wake time from 145 minutes to 100 minutes in elderly insomniacs 3
- Equivalent efficacy to 15 mg for treatment of transient insomnia 4
20-30 mg Dose
- 20 mg reduces subjective sleep latency by 23-29 minutes compared to placebo 5
- 30 mg increases total sleep time by 53-54.6 minutes versus placebo 2, 5
- 30 mg significantly reduces number of awakenings (1.0-1.24 fewer awakenings compared to placebo) 2
Adverse Effects
- 15 mg dose shows no notable increase in adverse effects versus placebo with minimal daytime impairment 2, 5
- 20 mg dose has modest increases in headache, blurred vision, depression, and confusion, though frequency is low overall 2
- 30 mg dose has higher incidence of drowsiness, lethargy, and vertigo with potential daytime impairment on psychomotor tests 2, 6
- Overall incidence of adverse effects is infrequent (7.8% of patients) and typically mild 7
Special Considerations
- When discontinuing temazepam, use a gradual taper to reduce the risk of withdrawal reactions 1
- Temazepam has a relatively short half-life (5-11 hours, longer in elderly) with no clinically important active metabolites 6
- The American Academy of Sleep Medicine suggests that the benefits of temazepam outweigh the harms, particularly for the 15 mg dose 2
- For patients requiring treatment of both sleep onset and maintenance insomnia, temazepam is an appropriate choice 2