Does temazepam (Restoril) affect respiratory rate?

From the Guidelines

Yes, temazepam can affect breathing, particularly by causing respiratory depression, especially at higher doses or when combined with other central nervous system depressants. Temazepam is a benzodiazepine medication commonly prescribed for short-term treatment of insomnia, typically at doses of 7.5-30 mg taken before bedtime. It enhances the action of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that reduces brain activity, including the neural pathways that control breathing 1. The risk of breathing problems is significantly higher in people with pre-existing respiratory conditions like sleep apnea, COPD, or asthma. Elderly patients are also more vulnerable to these effects. According to the 2023 American Heart Association guidelines, isolated benzodiazepine poisoning rarely causes life-threatening hypoventilation or hemodynamic instability, but the presence of concomitant opioid, ethanol, or other CNS depressant poisoning can increase this risk 1.

Key Considerations

• Temazepam can cause respiratory depression, especially when combined with other CNS depressants.
• The risk of breathing problems is higher in people with pre-existing respiratory conditions or elderly patients.
• If experiencing difficulty breathing, unusual sleepiness, or confusion while taking temazepam, seek medical attention immediately.
• Always take temazepam exactly as prescribed and inform your healthcare provider about all other medications you're taking to minimize these risks.
• The management of patients with benzodiazepine overdose includes establishing an open airway and providing bag-mask ventilation, followed by endotracheal intubation when appropriate, and considering the use of flumazenil, a competitive antagonist at the benzodiazepine binding site on the GABA-A receptor, although its use may precipitate refractory benzodiazepine withdrawal and seizures in patients with benzodiazepine tolerance 1.

Recommendations for Use

• Use temazepam with caution, especially in patients with pre-existing respiratory conditions or those taking other CNS depressants.
• Monitor patients for signs of respiratory depression, such as difficulty breathing or unusual sleepiness.
• Consider alternative treatments for insomnia that do not involve benzodiazepines, especially in high-risk patients.
• Follow the 2023 American Heart Association guidelines for the management of patients with cardiac arrest or life-threatening toxicity due to poisoning, which include recommendations for the use of flumazenil and other treatments for benzodiazepine overdose 1.

From the FDA Drug Label

Taking benzodiazepines with opioid medicines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, breathing problems (respiratory depression), coma and death. Concomitant use of benzodiazepines, including Temazepam, and opioids may result in profound sedation, respiratory depression, coma, and death. Manifestations of acute overdosage of temazepam can be expected to reflect the CNS effects of the drug and include somnolence, confusion, and coma, with reduced or absent reflexes, respiratory depression, and hypotension.

Temazepam can affect breathing, particularly when used with other central nervous system depressants, such as opioids. The risk of respiratory depression is increased with concomitant use, and can lead to serious side effects, including coma and death 2, 2. In cases of overdose, respiratory depression is a common manifestation 2.

From the Research

Effects of Temazepam on Breathing

• Temazepam is a benzodiazepine that can affect breathing, but its impact varies depending on the individual and the specific condition being treated 3, 4.
• In patients with obstructive sleep apnea (OSA), temazepam can worsen respiratory impairment during sleep, particularly in those with higher awake central chemosensitivity 3.
• However, in patients with severe normocapnic chronic obstructive pulmonary disease (COPD), temazepam 10mg does not appear to affect breathing and gas exchange 4.
• The effects of temazepam on breathing are not fully understood and may depend on various factors, including the dose and individual characteristics of the patient 5, 6.

Studies on Temazepam and Breathing

• A study published in the Journal of Sleep Research found that temazepam increased respiratory impairment during sleep in patients with OSA, particularly those with higher awake central chemosensitivity 3.
• A study published in Respiratory Medicine found that temazepam 10mg did not affect breathing and gas exchange in patients with severe normocapnic COPD 4.
• Other studies have investigated the effects of benzodiazepines on respiratory function, but the results are inconsistent and depend on various factors, including the specific benzodiazepine and the population being studied 5, 6.

Key Findings

• Temazepam can worsen respiratory impairment during sleep in patients with OSA, particularly those with higher awake central chemosensitivity 3.
• Temazepam 10mg does not appear to affect breathing and gas exchange in patients with severe normocapnic COPD 4.
• The effects of temazepam on breathing are not fully understood and require further study 5, 6, 7.