Nitrazepam

How it works

It potentiates the inhibitory neurotransmitter GABA at the GABA-A receptor, enhancing chloride channel opening to produce sedative, hypnotic and anxiolytic effects.

Prescribing in practice

• Benzodiazepines should be prescribed for the shortest possible time because of the risk of tolerance, dependence and withdrawal, and nitrazepam's long half-life predisposes to next-day sedation and accumulation, especially in older people.
• There is additive central nervous system and respiratory depression with alcohol and other sedatives, including opioids.
• Avoid abrupt discontinuation after regular use, as this can precipitate a withdrawal syndrome; withdraw gradually.

Monitoring

Review the continued need for treatment regularly and monitor for daytime drowsiness, falls and signs of dependence.

Counselling the patient

• This medicine can cause drowsiness the next day; take care when driving or operating machinery.
• Avoid alcohol while taking nitrazepam.
• Do not stop suddenly after taking it regularly; your prescriber will help you reduce it gradually.

Evidence & guidelines

Guidance from NICE and the MHRA emphasises short-term, lowest-effective use of hypnotic benzodiazepines such as nitrazepam because of dependence and next-day impairment.