What is the starting dose of Restoril (temazepam) for insomnia in adults?

Starting Dose of Restoril (Temazepam)

The recommended starting dose of Restoril (temazepam) for most adults with insomnia is 15 mg taken 30 minutes before bedtime, though 7.5 mg may be sufficient for some patients, elderly patients, or debilitated patients. 1

Standard Adult Dosing

• Start with 15 mg before retiring for most adults, as this is the FDA-recommended usual adult dose and demonstrates clinically meaningful improvements in sleep parameters 1
• The 15 mg dose increases total sleep time by approximately 64-99 minutes compared to placebo, with moderate quality evidence supporting this benefit 2, 3
• This dose improves sleep efficiency by approximately 14% versus placebo and reduces sleep latency by about 20 minutes 2, 3
• The 15 mg dose shows minimal adverse effects compared to placebo, with no notable increase in daytime impairment 3, 4

Lower Starting Dose Considerations

• For elderly or debilitated patients, initiate therapy with 7.5 mg until individual responses are determined 1
• A 7.5 mg dose may be sufficient for some patients, particularly for transient insomnia where improving sleep latency is the primary goal 1
• Studies in elderly insomniacs demonstrate that 7.5 mg effectively reduces total wake time (from 145 to 100 minutes) with minimal CNS and behavioral adverse effects 5
• The 7.5 mg dose demonstrates hypnotic effects in the first-night transient insomnia model, with linear dose-response improvements in sleep parameters 6

Dose Titration

• If 15 mg is insufficient, the dose may be increased to 30 mg before bedtime 1
• The 30 mg dose increases total sleep time by 53-55 minutes and reduces awakenings by 1.0-1.24 compared to placebo 2, 3
• However, the 30 mg dose carries higher risk of drowsiness, lethargy, vertigo, and potential daytime impairment on psychomotor tests 3, 4

Administration Timing

• Administer temazepam 30 minutes prior to bedtime for optimal effect 1, 6
• Peak plasma concentrations occur approximately 1.2-1.6 hours after dosing, which explains why the drug is more effective for sleep maintenance than sleep onset 1

Important Caveats

• The American Academy of Sleep Medicine found that benefits of temazepam 15 mg outweigh potential harms based on moderate quality evidence 2, 4
• When discontinuing, use a gradual taper to reduce risk of withdrawal reactions rather than abrupt cessation 1
• For patients with addiction history, consider alternative medications like ramelteon as suggested by the American Academy of Sleep Medicine 4