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Benzodiazepine Hypnotic Pregnancy: Avoid in pregnancy; neonatal withdrawal and respiratory depression

Nitrazepam

Brand names: Mogadon

Adult dose

Dose: 5 mg at bedtime
Route: Oral
Frequency: Once nightly
Max: 10 mg/night (2.5-5 mg in elderly)
Long half-life (15-40 hours) — significant next-day sedation. Generally superseded by shorter-acting agents or Z-drugs. Maximum 4 weeks use

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: Oral
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion

Dose adjustments

Renal

Use with caution; reduce dose

Hepatic

Avoid in severe hepatic impairment

Paediatric weight-based calculator

Seek specialist opinion

Clinical pearls

  • STOPP v3 and Beers Criteria 2023: Long-acting benzodiazepines (including nitrazepam) are particularly inappropriate in elderly — prolonged half-life leads to accumulation and disproportionate hangover, falls, and cognitive impairment
  • Among benzodiazepine hypnotics, nitrazepam has one of the longest half-lives — significantly worse next-day cognitive and motor impairment than shorter-acting alternatives
  • If a benzodiazepine hypnotic is required in elderly (unavoidable short-term), temazepam (intermediate half-life) is preferred over nitrazepam
  • Controlled Drug Schedule 4 Part I in UK
  • Taper on withdrawal — abrupt discontinuation after prolonged use risks seizures and severe anxiety; withdrawal protocol required

Contraindications

  • Respiratory failure
  • Sleep apnoea
  • Myasthenia gravis
  • Severe hepatic impairment

Side effects

  • Excessive daytime sedation (prolonged half-life)
  • Cognitive impairment
  • Falls and fractures
  • Ataxia
  • Dependence and withdrawal
  • Paradoxical excitation (elderly)
  • Respiratory depression

Interactions

  • CNS depressants (additive)
  • Alcohol (significantly enhanced sedation)
  • Opioids (additive respiratory depression)

Monitoring

  • Daytime sedation and cognitive function
  • Falls risk
  • Duration of use
  • Withdrawal symptoms

Reference: BNFc; BNF 90; AGS Beers Criteria 2023; STOPP/START v3; NICE CG49 (Insomnia). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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