Hypnotic drugs Hypnotic medications flurazepam, Dalmane

Hypnotic : flurazepam, Dalmane

Generic Name: flurazepam
Brand Name(s): Dalmane
Common Use: Hypnotic

Flurazepam, a benzodiazepine derivative, is a hypnotic agent which does not appear to decrease dream time as measured by rapid eye movements (REM). Furthermore, it decreases sleep latency and number of awakenings for a consequent increase in total sleep time.

In controlled sleep laboratory studies of 20 human insomniac subjects utilizing all night electroencephalograph (EEG), electromyograph (EMG), and electro-oculograph (EOG) recordings, flurazepam usually induced sleep within 22 minutes and usually provided 7 to 8 hours of sleep. Flurazepam is rapidly absorbed from the gastrointestinal tract and is rapidly metabolized. Both hydroxyethyl flurazepam (the major metabolite) and N-desalkyl flurazepam are active. The N-desalkyl metabolite is slowly excreted in the urine as the conjugated form. Because of the long half-life of this metabolite (47 to 100 hours), peak hypnotic effect of flurazepam may be reached after 2 to 3 nights of use.

Insomnia, characterized by difficulty in falling asleep, frequent nocturnal awakenings and/or early morning awakening. For short-term and intermittent use in patients with recurring insomnia and poor sleeping habits; however, the safety and efficacy of long-term use has not been established.

Contraindications
Known hypersensitivity to benzodiazepines. Since clinical investigations of flurazepam have not been carried out in children, currently it is not recommended for use in children under 15 years of age.

Adverse Side Effects

The most common adverse effects are dizziness, drowsiness, lightheadedness and ataxia. These adverse effects are particularly common in elderly and debilitated patients. (See Precautions). Severe sedation, lethargy, disorientation, probably indicative of drug intolerance or overdosage, have been reported.
Isolated instances of headache, heartburn, upset stomach, nausea, vomiting, constipation, diarrhea, gastrointestinal pain, nervousness, apprehension, irritability, weakness, palpitations, chest pains, and genitourinary complaints have been reported. However, in controlled studies, these appeared as often or more often with placebo than with the active drug.
There have also been rare occurrences of sweating, flushes, difficulty in focusing, blurred vision, faintness, hypotension, shortness of breath, pruritus, skin rash, dry mouth, bitter taste, excessive salivation, anorexia, euphoria, depression, slurred speech, confusion, restlessness, and hallucinations. Elevated AST (SGOT), ALT (SGPT), total and direct bilirubins, and alkaline phosphatase have been observed. Paradoxical reactions, such as excitement, stimulation and hyperactivity, have also been reported in rare instances.

Overdose

Symptoms:
Somnolence, confusion, coma.

Treatment:
Respiration, pulse and blood pressure should be monitored as in all cases of drug overdosage. General supportive measures should be employed, along with immediate gastric lavage. If excitation occurs in patients following flurazepam overdosage, barbiturates should not be used. As with the management of intentional overdosage with any drug, it should be borne in mind that multiple agents may have been ingested.

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