FLURAZEPAM HYDROCHLORIDE
(flure-az'e-pam)
Apo-Flurazepam  , Dalmane, Durapam, Novoflupam
Classifications: central nervous system agent; anxiolytic; sedative-hypnotic; benzodiazepine
Prototype: Lorazepam
Pregnancy Category: X
Controlled Substance: Schedule IV
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15 mg, 30 mg capsules
Benzodiazepine derivative, with hypnotic activity equal to or greater than that produced by barbiturates or chloral hydrate.
Mode and site of action not known; appears to act at limbic and subcortical levels of CNS to produce sedation, skeletal muscle
relaxation, and anticonvulsant effects.
Reduces sleep induction time; produces marked reduction of stage 4 sleep (deepest sleep stage) while at the same time increasing
duration of total sleep time.
Hypnotic in management of all kinds of insomnia (e.g., difficulty in falling asleep, frequent nocturnal awakening or early
morning awakening or both). Also for treatment of poor sleeping habits.
Prolonged administration; sleep apnea; intermittent porphyria; acute narrow-angle glaucoma; children <15 y; pregnancy (category
X), lactation.
Impaired renal or hepatic function; mental depression, psychoses, history of suicidal tendencies, addiction-prone individuals;
older adult or debilitated patients; COPD.
Sedative, Hypnotic
Adult: PO  15 y, 15–30 mg h.s.
Geriatric: PO 15 mg h.s.
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Oral
- Give once patient is in bed and ready to fall asleep.
- Store in light-resistant container with childproof cap at 15°–30° C (59°–86° F) unless otherwise
specified.
CNS: Residual sedation, drowsiness, light-headedness, dizziness, ataxia, headache, nervousness, apprehension, talkativeness, irritability, depression, hallucinations,
nightmares, confusion, paradoxic reactions: excitement, euphoria, hyperactivity, disorientation, coma (overdosage). Special Senses: Blurred vision, burning eyes. GI: Heartburn, nausea, vomiting, diarrhea, abdominal pain. Body as a Whole: Immediate allergic reaction, hypotension, granulocytopenia (rare), jaundice (rare).
Flurazepam may increase serum levels of total and direct bilirubin, alkaline phosphatase, AST, and ALT. False-negative urine glucose reactions may occur with Clinistix and Diastix; no effect with TesTape.
Drug: Alcohol, cns depressants, anticonvulsants potentiate CNS depression; cimetidine, disulfiram may increase flurazepam levels, thus increasing its toxicity. Herbal: Kava-kava, valerian may potentiate sedation.
Absorption: Readily absorbed from GI tract. Onset: 15–45 min. Duration: 7–8 h. Distribution: Crosses blood–brain barrier and placenta; distributed into breast milk. Metabolism: Metabolized in liver to active metabolites. Elimination: Excreted primarily in urine. Half-Life: 47–100 h.
Assessment & Drug Effects
- Monitor effectiveness. Hypnotic effect is apparent on second or third night of consecutive use and continues 1–2 nights
after drug is stopped (drug has a long half-life).
- Supervise ambulation. Residual sedation and drowsiness are relatively common. Excessive drowsiness, ataxia, vertigo, and falling
occur more frequently in older adults or debilitated patients.
- Monitor drug ingestion if patient has a history of drug abuse. Prolonged use of large doses can result in psychic and physical
dependence.
- Lab tests: Obtain blood counts and liver and kidney function with repeated use.
- Be aware that withdrawal symptoms have occurred 3 d after abrupt discontinuation after prolonged use and include worsening
of insomnia, dizziness, blurred vision, anorexia, GI upset, nasal congestion, paresthesias.
Patient & Family Education
- Avoid potentially hazardous activities until response to drug is known.
- Avoid alcohol. Concurrent ingestion with flurazepam intensifies CNS depressant effects; symptoms may occur even when alcohol
is ingested as long as 10 h after last flurazepam dose.
- Be aware of the possible additive depressant effects when drug is combined with barbiturates, tranquilizers, or other CNS
depressants.
- Do not change dose intervals or dosage. Do not take for a self-diagnosed problem.
- Ask physician about the desirability of discontinuing the drug if you become or intend to become pregnant during therapy.
- Note: Prolonged use of this hypnotic is inadvisable because insomnia is usually transient.
- Do not breast feed while taking this drug.
Prototype drug