Temazepam

Temazepam is a prescription benzodiazepine hypnotic used for the short-term treatment of insomnia, especially problems with sleep onset. It is marketed under various brand names and is available in oral capsule form in many countries.

Pharmacology and pharmacokinetics: Temazepam acts as a positive allosteric modulator of the GABA-A receptor, enhancing inhibitory neurotransmission to produce sedative effects. It typically has rapid onset, reaching effect within about 30 to 60 minutes. In adults, the elimination half-life is generally around 8 to 20 hours, though this can vary with age and liver function. Metabolism occurs mainly in the liver via glucuronidation to an inactive metabolite, contributing to a relatively lower burden of active metabolites compared with some other benzodiazepines.

Indications and use: It is indicated for short-term management of insomnia characterized by difficulty with sleep onset. Treatments are usually brief, often up to two to four weeks, with tapering if continued. Long-term use is discouraged due to risks of dependence, tolerance, and withdrawal symptoms.

Safety and adverse effects: Common effects include daytime drowsiness, dizziness, impaired coordination, and memory problems, particularly in older adults. Others may experience confusion or grogginess. Serious adverse effects are rare but can include paradoxical excitation or respiratory depression at high doses. Caution is advised in the elderly, in those with sleep apnea, hepatic impairment, or cognitive disorders.

Contraindications and interactions: Contraindicated in certain conditions such as hypersensitivity to benzodiazepines, acute narrow-angle glaucoma, and significant hepatic impairment; use during pregnancy and lactation is generally avoided. Interactions include potentiation of CNS depressants (notably alcohol), and possible altered levels with certain other drugs.

Regulatory status: Temazepam is a controlled substance in many jurisdictions (commonly Schedule IV in the United States) and is available by prescription only due to risks of dependence and misuse.