What is the maximum recommended dose of temazepam (benzodiazepine) for sleep in an adult?

Maximum Dose of Temazepam for Sleep in Adults

The maximum recommended dose of temazepam for insomnia in adults is 30 mg before bedtime, as specified by FDA labeling. 1

FDA-Approved Dosing Guidelines

The FDA label provides clear dosing parameters 1:

• Standard adult dose: 15 mg before bedtime
• Lower dose option: 7.5 mg may be sufficient for some patients
• Maximum dose: 30 mg for those requiring higher doses
• Elderly/debilitated patients: Start with 7.5 mg until individual response is determined

Evidence Supporting the 30 mg Maximum

The American Academy of Sleep Medicine clinical practice guideline evaluated temazepam at multiple doses and found that 30 mg represents the upper limit studied in clinical trials 2:

• 30 mg demonstrated significant efficacy with 40-45 minute reductions in sleep latency compared to placebo 2
• Total sleep time increased by 53-54.6 minutes at the 30 mg dose 2
• Number of awakenings decreased by 1.0-1.24 compared to placebo 2, 3

Safety Considerations at Maximum Dose

The 30 mg dose carries a higher adverse effect burden compared to lower doses 3:

• Increased incidence of drowsiness, lethargy, and vertigo
• Potential daytime impairment on psychomotor tests
• Greater risk of morning "hangover" effects 4

In contrast, the 15 mg dose shows minimal adverse effects versus placebo with no notable daytime impairment 3, making it the preferred starting point.

Clinical Algorithm for Dosing

Start with 15 mg as the recommended usual adult dose 1:

• This provides approximately 99 minutes increased total sleep time 3
• Minimal adverse effects at this dose 3

Consider 7.5 mg for:

• Transient insomnia where improving sleep latency is the primary goal 1
• Elderly patients (mandatory dose reduction) 5, 1
• Debilitated patients 1
• Patients with hepatic impairment (50% dose reduction required) 5

Escalate to 30 mg only if:

• 15 mg proves insufficient after adequate trial
• Patient tolerates lower doses without adverse effects
• Benefits clearly outweigh risks of increased side effects

Critical Safety Warnings

Never exceed 30 mg - no evidence supports higher doses and risk increases substantially 1:

• FDA warnings regarding complex sleep behaviors apply to all doses 5
• Risk of daytime memory impairment increases with dose 5
• Potential association with dementia in observational studies 5

Gradual taper required for discontinuation to reduce withdrawal reactions 1:

• Abrupt discontinuation can cause rebound insomnia 5
• If withdrawal reactions develop, pause taper or increase to previous dose level 1

Avoid combining with 5:

• Alcohol
• Other CNS depressants
• Use during sleep restriction

Administer on empty stomach to maximize effectiveness 5