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Benzodiazepine Hypnotic — Schedule 3 Controlled Drug Pregnancy: Avoid — benzodiazepines cause fetal hypotonia, respiratory depression, and withdrawal. Non-pharmacological sleep management preferred in pregnancy.

Temazepam

Brand names: Generic only (Temazepam) — no branded preparation

Adult dose

Dose: Insomnia: 10–20mg at bedtime; elderly: 10mg at bedtime. Maximum treatment course: 2–4 weeks.
Route: Oral
Frequency: Once nightly at bedtime
Max: 40mg (non-elderly adults — rarely needed); 10mg (elderly)
Schedule 3 Controlled Drug (CD3) — requires CD prescription. Short-to-intermediate acting benzodiazepine (half-life 5–11h). Minimal hangover sedation compared to nitrazepam. Use limited to maximum 4 weeks — tolerance and dependence develop rapidly. Should not be prescribed routinely — consider sleep hygiene, CBT-i first (NICE NG215).

Paediatric dose

Route: Oral
Frequency: Once nightly
Max: Not applicable
Not licensed under 18 years. Do not use in children or adolescents for insomnia. Seek specialist child and adolescent psychiatry opinion if sedation needed.

Dose adjustments

Renal

Use with caution in severe renal impairment — accumulation risk; start with lowest dose (10mg).

Hepatic

Avoid in severe hepatic impairment — accumulation and encephalopathy risk.

Clinical pearls

  • Antidote: flumazenil 200 micrograms IV then 100 micrograms every 60 seconds (max 1mg) — reverses sedation; shorter half-life than temazepam, repeat doses may be needed
  • Tolerance develops within 2 weeks — efficacy wanes and patients require escalating doses to achieve same sleep effect; strictly limit to 2–4 weeks
  • Rebound insomnia: insomnia transiently worsens when temazepam is stopped — warn patients that this is temporary and not a sign that they need to restart the drug
  • Preferred over nitrazepam in most patients (shorter half-life, less next-day sedation, less falls risk in elderly)

Contraindications

  • Respiratory failure
  • Myasthenia gravis
  • Sleep apnoea syndrome
  • Severe hepatic impairment
  • Acute narrow-angle glaucoma
  • Hypersensitivity to benzodiazepines

Side effects

  • Residual sedation (less than nitrazepam)
  • Anterograde amnesia
  • Dependence and withdrawal (insomnia rebound, anxiety, sweating, seizures)
  • Falls and fractures (elderly)
  • Paradoxical agitation
  • Respiratory depression (at high doses or with CNS depressants)

Interactions

  • CNS depressants, opioids, alcohol — additive respiratory depression
  • Rifampicin — reduces temazepam efficacy (enzyme induction)
  • Theophylline — may antagonise sedative effect

Monitoring

  • Duration of use (strict 2–4 week limit)
  • Dependence symptoms (increasing dose request, withdrawal symptoms on missing dose)
  • Falls risk (particularly elderly)
  • Sleep diary

Reference: BNFc; BNF 90; NICE NG215 (Insomnia); NICE CG22 (Anxiety). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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