Temazepam Dosing and Treatment Duration for Insomnia
For adults with insomnia, start with temazepam 15 mg at bedtime, which is the recommended initial dose that balances efficacy with minimal adverse effects, and limit treatment to 7-10 days for short-term insomnia. 1
Initial Dosing Strategy
- Begin with 15 mg at bedtime for most adults, as this dose increases total sleep time by approximately 64-99 minutes compared to placebo and improves sleep efficiency by 13-14% 2, 3
- Use 7.5 mg for elderly or debilitated patients until individual responses are determined 1
- For transient insomnia specifically, 7.5 mg may be sufficient to improve sleep latency and is clinically equivalent to 15 mg 1, 4
Dose Titration
- If 15 mg is insufficient, increase to 30 mg for patients requiring greater symptom control 1
- The 20 mg dose reduces sleep latency by 23-29 minutes and increases total sleep time by 18-78 minutes versus placebo 2, 3
- The 30 mg dose increases total sleep time by 53-55 minutes and reduces awakenings by 1.0-1.24 episodes compared to placebo 2, 3
Treatment Duration
Limit temazepam to 7-10 days for short-term insomnia treatment, as this is the FDA-approved duration and the timeframe supported by clinical trial data 1
- The efficacy trials supporting temazepam were 2 weeks in duration, with formal assessment at end of treatment 1
- For elderly patients, an 8-week study showed temazepam remained safe with few adverse effects, though this exceeds standard recommendations 5
- After initial short-term use, employ intermittent dosing as needed rather than continuous nightly administration 6
Adverse Effect Profile by Dose
- 15 mg shows no notable increase in adverse effects versus placebo with minimal daytime impairment 2, 3
- 20 mg has modest increases in headache, blurred vision, depression, and confusion, though overall frequency remains low 2, 3
- 30 mg carries higher risk of drowsiness, lethargy, vertigo, and daytime psychomotor impairment 2, 3
Critical Discontinuation Protocol
Use gradual tapering when discontinuing temazepam to prevent withdrawal reactions 1
- If withdrawal symptoms develop, pause the taper or increase back to the previous dose level 1
- Subsequently decrease more slowly to minimize risk 1
Important Clinical Considerations
- Temazepam is absorbed slowly (peak at 2-3 hours) and may not consistently reduce sleep onset latency when taken at bedtime 7, 8
- The drug is most effective for sleep maintenance rather than sleep initiation, making it appropriate for patients with middle-of-night or early morning awakening 9, 7
- In elderly patients (7.5 mg dose), total wake time improved from 145 to 100 minutes with short-term use, with no rebound insomnia upon withdrawal 6
- For patients with addiction history, consider alternative medications like ramelteon rather than benzodiazepines 3