Temazepam (Restoril)

This article provides a detailed overview of temazepam, including how it works, its indications, side effects, precautions, and interactions with medications.

Key Takeaways:

• Temazepam is a benzodiazepine medication that helps calm down mental activity. It is primarily used for the short-term treatment of insomnia, particularly for those who have difficulty staying asleep.

• Temazepam may cause drowsiness, impaired next-day function, and many other possible side effects, including potentially dangerous ones, such as carrying out specific behaviors while asleep (e.g., driving, eating food).

• Temazepam interacts with many medications, including severe and possibly life-threatening interactions with other CNS depressants. There is also a risk of dependence and addiction with long-term use.

Understanding Temazepam

Temazepam is a prescription medication that belongs to the benzodiazepine class of drugs, which are all known for their ability to slow down activity in the central nervous system (CNS). Temazepam was first FDA-approved in 1981, and since then has primarily been used to improve sleep in individuals with insomnia, particularly for individuals who have trouble staying asleep. ^[1]

How Does it Work?

Insomnia is thought to be due in part to hyperarousal and an overactive brain and nervous system, which makes it difficult to sleep. Thus, Temazepam works by slowing down activity in the brain and nervous system, which in turn promotes sleep.

Specifically, temazepam binds to benzodiazepine receptors, which increases the effects of GABA, an inhibitory neurotransmitter. This leads to calming effects in the CNS, such as sedation, muscle relaxation, and decreased anxiety. ^[1]

Brand Names

In the United States, the brand name for temazepam is Restoril®. Other brand names of temazepam in different countries include:

• Euhypnos®

• Norkotral®

• Normison®

This list does not provide all brand names.

What is Temazepam Used For?

Temazepam is approved for the short-term treatment of insomnia, typically in the range of 7 to 10 days. It is particularly beneficial for sleep maintenance in insomnia, whereby it helps to reduce nighttime and/or early awakenings, thus contributing to more restful sleep. Temazepam may also help individuals fall asleep faster as well, although this is not its strongest effect. ^{[1] [2]}

Temazepam is a common drug for insomnia overall, with over 2 million prescriptions filled in the United States alone each year. ^[1]

Off-Label Uses

Temazepam may also be used off-label for other sleep difficulties associated with: ^[1]

• Jet lag

• Shift work

• Acute stress

Other off-label uses of temazepam include: ^[1]

• Acute mountain sickness.

• Panic and anxiety disorders (short-term basis, typically 7 to 10 days).

• Anxiety reduction/sedation before surgery.

• Nocturnal myoclonus (which involves excessive periodic leg movements during sleep).

Temazepam Side Effects

There are several possible side effects of temazepam. The most common temazepam side effects are: ^{[1] [3] [4]}

• Drowsiness

• Certain related next-day symptoms, such as:

• A “drugged” or “hungover” feeling

• Decreased alertness

• Tiredness

• Lightheadedness

• Nervousness

• Dizziness

• Trouble with balance/unsteadiness

• Dry mouth

Other possible side effects of temazepam include: ^{[1] [2] [3] [4]}

• Vivid dreams

• Nightmares

• Depression

• Nausea

• Vomiting

• Diarrhea

• Constipation

• Stomach discomfort

• Headache

• Disorientation

• Giddiness

This list may not contain all side effects. Make sure to tell your doctor if you notice these or any other side effects after taking temazepam.

Rare and Severe Side Effects

Some side effects of temazepam are severe and possibly life-threatening. While these are not as common, it’s crucial to watch out for any of these rarer side effects, especially those that are severe: ^{[1] [2] [3] [4]}

• Changes in thoughts or behaviors: This includes:

• Paranoia.

• Aggressiveness.

• New or worsening depression.

• Confusion.

• Thoughts of suicide.

• Agitation.

• Restlessness.

• Feeling numb.

• Hallucinations.

• Delusions.

• Irrational behaviors.

• Unusually outgoing or extroverted behavior.

• Feeling outside of your body.

• Heart palpitations

• Jaundice: This is when the whites of your eyes or skin turn yellow. It may indicate liver problems.

• Memory loss or memory impairment

• Slurred speech

• Severe allergic reactions (anaphylaxis): Symptoms include:

• Swelling of the lips, mouth, eyes, throat, or tongue.

• Difficulty breathing (may involve a gasping or choking feeling).

• Trouble swallowing.

• Rash.

• Hives.

• Sudden confusion, drowsiness, or dizziness.

• Nausea or vomiting.

• Difficulty urinating or urinating more than usual

Some people taking temazepam have also reported complex sleep behaviors, which are abnormal and potentially dangerous behaviors that occur during sleep, such as talking on the phone, driving, walking, having sex, and preparing and eating food. Most often, they do not remember doing any of these activities the following day. ^{[2] [4]}

Contact your doctor right away if you notice any of these side effects.

Is it Addictive?

Temazepam has the potential to be addictive, particularly when it is misused, such as taking a larger dose than prescribed, or combining it with other drugs or medications. The risk of addiction also increases when temazepam is taken long-term. Due to its potential for abuse and addiction, temazepam is listed as a Schedule IV controlled substance under the Drug Enforcement Administration’s (DEA’s) Controlled Substances Act. ^{[1] [3]}

Temazepam is not likely to be addictive if you take it at a low dose (e.g., 15 mg or less) for a short period, such as a few days to 2 weeks. However, even when used as prescribed, it may cause physical dependence in some individuals. ^{[2] [3]}

Temazepam Dosage

The recommended dose of temazepam for adults with insomnia is 15 mg, approximately 30 minutes before bedtime. This can be increased to a maximum of 30 mg if the lower dose does not provide strong enough benefits. ^{[1] [4]}

Elderly individuals are started at a lower dose of 7.5 mg, due to a greater drug sensitivity and heightened risk of side effects. ^[4]

Methods of Administration

Temazepam is available as oral capsules in the United States and also as oral tablets and an oral solution in other countries. The oral capsules are formulated at the following strengths: ^[1]

• 7.5 mg

• 15 mg

• 22.5 mg

• 30 mg

The temazepam tablets are available in strengths of 10 mg and 20 mg. The oral solution of temazepam contains a dose concentration of 10 mg/5 mL. ^[3]

Precautions

There are several important precautions to understand when using temazepam. Some individuals require careful monitoring and cautious use, including the following populations: ^{[1] [2] [4]}

• Breastfeeding women: There is a chance that temazepam may exist in breastmilk, although it is minimal compared to some other drugs. Caution is still advised.

• Elderly adults (older than 65\): There is an increased risk of oversedation, falls, dizziness, and other side effects. If deemed necessary to use at all, the starting dose should be 7.5 mg.

• Individuals with any of the following conditions or symptoms: There is an increased risk of side effects or harmful outcomes due to the way temazepam affects various parts of the body.

• Sleep apnea

• Lung disease or any breathing problems

• Liver or kidney impairments

• Alcoholism or drug addiction (extreme caution, if used at all)

• Depression, suicidal thoughts, or other mental health issues

Temazepam is contraindicated and, thus, should not be used in the following populations: ^{[1] [4]}

• Children

• Pregnant women

• Or women planning to become pregnant.

• Individuals with a known allergy or hypersensitivity to temazepam.

Taking a higher dose than prescribed, or combining temazepam with other medications, can lead to overdose. Symptoms of overdose include severe drowsiness, confusion, slowed breathing, and coma. If any of these symptoms occur, contact your local emergency number immediately. ^{[1] [2]}

Temazepam may also cause drowsiness, decreased alertness, trouble concentrating, and related symptoms the following day. It may also increase the risk of falls if you get up during the night. The next-day effects of temazepam may make it unsafe to drive, operate machinery, or perform other complex physical or mental tasks, even if you feel fully awake and alert. Do not engage in any of these activities until you know how temazepam affects you and you receive your doctor’s approval to do so. ^{[2] [5]}

Harmful Interactions

Temazepam interacts with many medications and other substances. Temazepam has dangerous and potentially life-threatening interactions when combined with other drugs that depress the CNS, such as: ^[1]

• Opioids (e.g., morphine, codeine, oxycodone, fentanyl)

• Other benzodiazepines (e.g., midazolam, triazolam)

• Non-benzodiazepine sedative-hypnotics (e.g., zaleplon, zolpidem)

• Alcohol

The combination of temazepam and any of these substances may lead to severe sedation, slowed or shallow breathing, confusion, and coma or death in severe instances.

Temazepam also interacts with several other medications, including: ^{[1] [2] [3]}

• Antipsychotics (e.g., chlorpromazine, fluphenazine)

• Antihistamines (e.g., diphenhydramine, cetirizine)

• Barbiturates (e.g., amobarbital, phenobarbital)

• Certain monoamine oxidase inhibitors (MAOIs) (e.g., phenelzine)

• Muscle relaxants (methocarbamol, baclofen)

• Antifungals (e.g., fluconazole)

• Antihypertensives (e.g., ramipril, losartan)

• Antibiotics (e.g., rifampicin)

• Antivirals (e.g., ritonavir)

This list does not provide all possible interactions. Make sure to tell your doctor everything you take or have taken in the past, including prescription and over-the-counter medicines, vitamins, herbs, and dietary supplements.

Safe Storage

For safe storage, keep temazepam tightly closed in the original container it came in, and out of the reach of children. Store it at room temperature and away from excess heat and moisture (e.g., not in the bathroom).